☰ INDEX
NEET PG 2018
NEET PG 2019
NEET PG 2020
NEET PG 2021
NEET PG 2022
NEET PG 2023
NEET PG August 2024 (Evening Batch)
NEET PG August 2024 (Morning Batch)
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 293 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Identify the thickened nerve marked in the arrow in the image shown below:", "options": [{"label": "A", "text": "Great auricular nerve", "correct": true}, {"label": "B", "text": "Lesser occipital nerve", "correct": false}, {"label": "C", "text": "Facial nerve", "correct": false}, {"label": "D", "text": "Auriculotemporal nerve", "correct": false}], "correct_answer": "A. Great auricular nerve", "question_images": ["https://image.prepladder.com/content/HP5JqOvlIm48QSZHuhJ11712223951.png"], "explanation_images": [], "explanation": "<p>Correct Option A - Great &lt;span class=\"customMeta\" data-dictid=\"e825a1e928169277718206e4709c41\"&gt;auricular&lt;/span&gt; nerv\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Broca’s area is situated in the_________.", "options": [{"label": "A", "text": "Inferior frontal gyrus", "correct": true}, {"label": "B", "text": "Superior temporal gyrus", "correct": false}, {"label": "C", "text": "Angular gyrus", "correct": false}, {"label": "D", "text": "Postcentral gyrus", "correct": false}], "correct_answer": "A. Inferior frontal gyrus", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/DQGI38MTsKVW3Na7ch2k1714998954.png"], "explanation": "<p>Correct Option A - Inferior &lt;span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\"&gt;frontal&lt;/span&gt; gyru\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following cranial nerve nuclei is not a part of the special visceral afferent (SVA) column?", "options": [{"label": "A", "text": "Facial nerve", "correct": false}, {"label": "B", "text": "Trochlear nerve", "correct": true}, {"label": "C", "text": "Vagus nerve", "correct": false}, {"label": "D", "text": "Glossopharyngeal nerve", "correct": false}], "correct_answer": "B. Trochlear nerve", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Trochlear nerv\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The joint between the attachment of the 8 th and 9 th rib to the 7 th rib is a:", "options": [{"label": "A", "text": "Fibrocartilaginous joint", "correct": false}, {"label": "B", "text": "Symphyseal joint", "correct": false}, {"label": "C", "text": "Synovial joint", "correct": true}, {"label": "D", "text": "Fibrous joint", "correct": false}], "correct_answer": "C. Synovial joint", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/RHHrEfHv4afXfXucEUQz1715318689.png"], "explanation": "<p>Correct Option C - Synovial j\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which is the last fontanelle to close?", "options": [{"label": "A", "text": "Anterior", "correct": true}, {"label": "B", "text": "Posterior", "correct": false}, {"label": "C", "text": "Occipital", "correct": false}, {"label": "D", "text": "Mastoid", "correct": false}], "correct_answer": "A. Anterior", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements about Sibson's fascia is not correct?", "options": [{"label": "A", "text": "Attached to the inner border of 2 nd rib", "correct": true}, {"label": "B", "text": "Covers apical part of lung", "correct": false}, {"label": "C", "text": "Not a part of scalenus minimus muscle", "correct": false}, {"label": "D", "text": "Vessels pass above the fascia", "correct": false}], "correct_answer": "A. Attached to the inner border of 2 nd rib", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A: Attached to the inner border of 2\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The structure not passing through the aortic opening of the diaphragm is:", "options": [{"label": "A", "text": "Aorta", "correct": false}, {"label": "B", "text": "Azygous vein", "correct": false}, {"label": "C", "text": "Thoracic duct", "correct": false}, {"label": "D", "text": "Vagal trunk", "correct": true}], "correct_answer": "D. Vagal trunk", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/OuCgrxKUGIw58tMgTipO1715322455.png"], "explanation": "<p>Correct Option D - Vagal trunk\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The hard palate contains_________.", "options": [{"label": "A", "text": "Keratinized epithelium, submucosa, minor salivary glands", "correct": true}, {"label": "B", "text": "Keratinized epithelium, absent submucosa, no salivary glands", "correct": false}, {"label": "C", "text": "Non-keratinized epithelium, submucosa, minor salivary glands", "correct": false}, {"label": "D", "text": "Non-keratinized epithelium, absent submucosa, minor salivary glands", "correct": false}], "correct_answer": "A. Keratinized epithelium, submucosa, minor salivary glands", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Keratinized epithelium, submucosa, minor salivary g\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:571px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hard Palate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p> Soft Palate</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Epithelium</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stratified <span class=\"customMeta\" data-dictid=\"5be0ee4ea316927771997104326685\">squamous</span> epithelium</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stratified <span class=\"customMeta\" data-dictid=\"5be0ee4ea316927771997104326685\">squamous</span> epithelium</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Keratinization</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Keratinized</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Keratinized</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Submucosa</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Minor Salivary Glands</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present (more abundant)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Connective Tissue</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dense <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Loose <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Muscle</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None or minimal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abundant muscle fibers</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mucous Glands</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Few</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present (more abundant)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blood Vessels</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Well-vascularized</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Well-vascularized</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the function of the muscle marked as A in the image below, at the metacarpophalangeal joint?", "options": [{"label": "A", "text": "Flexion", "correct": true}, {"label": "B", "text": "Extension", "correct": false}, {"label": "C", "text": "Adduction", "correct": false}, {"label": "D", "text": "Abduction", "correct": false}], "correct_answer": "A. Flexion", "question_images": ["https://image.prepladder.com/content/mTMwfIwFn9tJcg3DzWJL1715862725.png"], "explanation_images": ["https://image.prepladder.com/content/IqVZULYWUH7gk8XHYgcX1715862918.png"], "explanation": "<p>Correct Option A: F\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which among the following is a tensor of vocal cords?", "options": [{"label": "A", "text": "Cricothyroid", "correct": true}, {"label": "B", "text": "Lateral cricoarytenoid", "correct": false}, {"label": "C", "text": "Thyroarytenoids", "correct": false}, {"label": "D", "text": "Posterior cricoarytenoids", "correct": false}], "correct_answer": "A. Cricothyroid", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Cricoth\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Muscle</strong></p>\n</td>\n<td>\n<p><strong>Action</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Cricothyroid</p>\n</td>\n<td>\n<p>Tenses vocal cords, increases pitch of voice</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Thyroarytenoid</p>\n</td>\n<td>\n<p>Relaxation of vocal cords, controls vocal cord thickness</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Lateral Cricoarytenoid</p>\n</td>\n<td>\n<p><strong>Adducts </strong>vocal cords, closes vocal cords</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Posterior Cricoarytenoid</p>\n</td>\n<td>\n<p><strong>Abducts </strong>vocal cords, opens vocal cords for breathing</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Aryepiglottic</p>\n</td>\n<td>\n<p>Closes the laryngeal <span class=\"customMeta\" data-dictid=\"42380fc2fb169277719066eff35739\">inlet</span> during swallowing</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Vocalis</p>\n</td>\n<td>\n<p>Adjusts vocal cord tension, fine-tunes pitch and volume</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Interarytenoids</p>\n</td>\n<td>\n<p>Adducts vocal cords, closes <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> part of glottis</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Transverse Arytenoids</p>\n</td>\n<td>\n<p>Adducts vocal cords, closes <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> part of glottis</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Oblique Arytenoids</p>\n</td>\n<td>\n<p>Adducts vocal cords, closes <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> part of glottis</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Cricopharyngeus</p>\n</td>\n<td>\n<p>Constricts the upper end of the esophagus</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The nerve of the second branchial arch is?", "options": [{"label": "A", "text": "Glossopharyngeal nerve", "correct": false}, {"label": "B", "text": "Trigeminal nerve", "correct": false}, {"label": "C", "text": "Facial nerve", "correct": true}, {"label": "D", "text": "Vagal nerve", "correct": false}], "correct_answer": "C. Facial nerve", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\"&gt;Facial&lt;/span&gt; nerv\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is true about the iliopubic tract?", "options": [{"label": "A", "text": "It is a thickening of the lumbar fascia", "correct": false}, {"label": "B", "text": "It lies anterior to the Poupart’s ligament", "correct": false}, {"label": "C", "text": "It inserts into t he pubic tubercle in front of the conjoint tendon", "correct": false}, {"label": "D", "text": "Its fibers fan out with fascia iliaca laterally", "correct": true}], "correct_answer": "D. Its fibers fan out with fascia iliaca laterally", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D: Its fibers fan out with &lt;span class=\"customMeta\" data-dictid=\"65483c739e169277720294dce50377\"&gt;fascia&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Ureteric bud develops from:", "options": [{"label": "A", "text": "Mesonephric duct", "correct": true}, {"label": "B", "text": "Metanephros", "correct": false}, {"label": "C", "text": "Pronephros", "correct": false}, {"label": "D", "text": "Genital sinus", "correct": false}], "correct_answer": "A. Mesonephric duct", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Mesonephric du\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Structure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Developmental Origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Function/Significance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ureteric bud</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mesonephric duct</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Arises from the mesonephric <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> (Wolffian duct)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gives rise to the ureter, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> pelvis,calyces, and collecting ducts</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metanephric mesenchyme</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metanephric mesenchyme</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Interacts with the ureteric <span class=\"customMeta\" data-dictid=\"fbaff1edd216927771835557d40049\">bud</span> to <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> the kidney</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pronephros</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pronephric mesoderm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Regresses early in development and does not</p>\n<p>contribute to the formation of the ureteric bud</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Genital sinus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Endodermal tissue</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involved in the development of the urogenital</p>\n<p>system, including <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> and urethra</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During which developmental week does the heartbeat initiate in the cardiac region?", "options": [{"label": "A", "text": "2 nd week", "correct": false}, {"label": "B", "text": "4 th week", "correct": true}, {"label": "C", "text": "6 th week", "correct": false}, {"label": "D", "text": "10 th week", "correct": false}], "correct_answer": "B. 4 th week", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - 4\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Developmental Stage</strong></p>\n</td>\n<td>\n<p><strong>Heartbeat</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>3rd week of <span class=\"customMeta\" data-dictid=\"55b88ac71d169277718832be1a82c7\">gestation</span> (21-22 days)</p>\n</td>\n<td>\n<p>Begins as a simple <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> structure and initiates <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">spontaneous</span> contractions</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>4th week of gestation</p>\n</td>\n<td>\n<p>Heart tube undergoes looping, and the heart starts beating rhythmically</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>5th week of gestation</p>\n</td>\n<td>\n<p>Heart chambers begin to form, and the heart rate increases</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>8th week of gestation</p>\n</td>\n<td>\n<p>Four-chambered heart is well-formed, and <span class=\"customMeta\" data-dictid=\"bf4c28aebb1692777188074f2facbb\">heartbeat</span> can be detected using ultrasound</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>9th-10th week of gestation</p>\n</td>\n<td>\n<p>Heartbeat becomes more regular and coordinated</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>End of 12th week of gestation</p>\n</td>\n<td>\n<p>Fetal heart rate can be heard using a <span class=\"customMeta\" data-dictid=\"eb476e70a316927771861ad68beaae\">Doppler</span> device</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 15-year-old girl presents with itchy lesions on her arm as shown. Her family history is positive for asthma . What could be the most probable diagnosis?", "options": [{"label": "A", "text": "Seborrhoeic dermatitis", "correct": false}, {"label": "B", "text": "Atopic dermatitis", "correct": true}, {"label": "C", "text": "Allergic contact dermatitis", "correct": false}, {"label": "D", "text": "Erysipelas", "correct": false}], "correct_answer": "B. Atopic dermatitis", "question_images": ["https://image.prepladder.com/content/tdEO1i0U71Vl2Drbir8H1713789774.png"], "explanation_images": ["https://image.prepladder.com/content/4xMB3ycDTh9WdCx9SALq1713789791.png"], "explanation": "<p>Correct Option B: A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which one of the subsequent options represents a primary skin lesion?", "options": [{"label": "A", "text": "Crust", "correct": false}, {"label": "B", "text": "Atrophy", "correct": false}, {"label": "C", "text": "Purpura", "correct": true}, {"label": "D", "text": "Induration", "correct": false}], "correct_answer": "C. Purpura", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C: Purpu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is your diagnosis?", "options": [{"label": "A", "text": "Mongolian spot", "correct": false}, {"label": "B", "text": "Nevus of Ito", "correct": false}, {"label": "C", "text": "Congenital melanocytic nevus", "correct": false}, {"label": "D", "text": "Becker’s nevus", "correct": true}], "correct_answer": "D. Becker’s nevus", "question_images": ["https://image.prepladder.com/content/AzdR0AMkhzDTyDAxEaf21747749762.png"], "explanation_images": ["https://image.prepladder.com/content/Aqk6nSedNmQrsa36tmnc1747749898.png", "https://image.prepladder.com/content/UHbc9yAOhG9uVoLI26QC1747749818.png", "https://image.prepladder.com/content/TKDm4q9S7dEcCF5nRMYl1747749853.png"], "explanation": "<table>\n<thead>\n<tr>\n<th>Feature</th>\n<th>Description</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td><strong>Onset</strong></td>\n<td>Typically appears during adolescence</td>\n</tr>\n<tr>\n<td><strong>Site</strong></td>\n<td>Commonly over the <strong>shoulder, upper back, or chest</strong></td>\n</tr>\n<tr>\n<td><strong>Appearance</strong></td>\n<td>Hyperpigmented, <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> patch</td>\n</tr>\n<tr>\n<td><strong>Hair growth</strong></td>\n<td><strong>Hypertrichosis</strong> often develops over the lesion</td>\n</tr>\n<tr>\n<td><strong>Gender</strong></td>\n<td>More common in <strong>males</strong></td>\n</tr>\n<tr>\n<td><strong>Hormonal link</strong></td>\n<td>May be associated with <strong>androgen sensitivity</strong> (increased at puberty)</td>\n</tr>\n<tr>\n<td><strong>Malignancy</strong></td>\n<td>No <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> potential</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which organism is typically responsible for causing verruca vulgaris?", "options": [{"label": "A", "text": "Human papillomavirus – 1", "correct": false}, {"label": "B", "text": "Human papillomavirus – 3", "correct": false}, {"label": "C", "text": "Human papillomavirus – 10", "correct": false}, {"label": "D", "text": "Human papillomavirus – 2", "correct": true}], "correct_answer": "D. Human papillomavirus – 2", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Wk7ATZAJMS2FL4gNjYJ21713955707.png", "https://image.prepladder.com/content/MsLs1qCIMcYCHpJ9y58A1713955721.png"], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"772d623b06169277718976e9488c37\"&gt;Human papillomavirus&lt;/span&gt; – 2\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the cause of cutis marmorata?", "options": [{"label": "A", "text": "Exposure to cold temperature", "correct": true}, {"label": "B", "text": "Humidity", "correct": false}, {"label": "C", "text": "Exposure to hot temperature", "correct": false}, {"label": "D", "text": "An adverse reaction to drugs", "correct": false}], "correct_answer": "A. Exposure to cold temperature", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/P1MMsn1tjMXUDc7SwkmB1713937282.png"], "explanation": "<p>Correct Option A: Exposure to cold temperatu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Varicella – zoster virus remains dormant in the:", "options": [{"label": "A", "text": "Medulla oblongata", "correct": false}, {"label": "B", "text": "Dorsal root ganglion", "correct": true}, {"label": "C", "text": "Skin", "correct": false}, {"label": "D", "text": "Ventral root", "correct": false}], "correct_answer": "B. Dorsal root ganglion", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\"&gt;Dorsal&lt;/span&gt; root gang\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is false regarding scleredema?", "options": [{"label": "A", "text": "The dermis is 3-4 times thicker than normal", "correct": false}, {"label": "B", "text": "Erythema and peau d’ orange appearance of the skin be seen", "correct": false}, {"label": "C", "text": "Can occur in association with diabetes", "correct": false}, {"label": "D", "text": "Associated with sclerodactyly or Raynauds phenomenon", "correct": true}], "correct_answer": "D. Associated with sclerodactyly or Raynauds phenomenon", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D:Associated with &lt;span class=\"customMeta\" data-dictid=\"fcf91ea5b91692777198dee5ea3d93\"&gt;sclerodactyly&lt;/span&gt; or Raynauds ph\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following nerves is responsible for referred otalgia from tonsillitis?", "options": [{"label": "A", "text": "Glossopharyngeal nerve", "correct": true}, {"label": "B", "text": "Facial nerve", "correct": false}, {"label": "C", "text": "Trigeminal nerve", "correct": false}, {"label": "D", "text": "Vagus nerve", "correct": false}], "correct_answer": "A. Glossopharyngeal nerve", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A: Glossopharyngeal nerv\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Water’s view best visualizes which of the following sinuses?", "options": [{"label": "A", "text": "Maxillary sinus", "correct": true}, {"label": "B", "text": "Ethmoidal sinus", "correct": false}, {"label": "C", "text": "Frontal sinus", "correct": false}, {"label": "D", "text": "Sphenoid sinus", "correct": false}], "correct_answer": "A. Maxillary sinus", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/us4knwi094HS3ySFAzjG1714392542.png", "https://image.prepladder.com/content/Y5kWv0iImonTni7WUmku1714392806.png"], "explanation": "<p>Correct Option A - Maxillary sinu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The following instrument is used in", "options": [{"label": "A", "text": "Septoplasty", "correct": false}, {"label": "B", "text": "Myringoplasty", "correct": false}, {"label": "C", "text": "Myringotomy", "correct": true}, {"label": "D", "text": "Adenoidectomy", "correct": false}], "correct_answer": "C. Myringotomy", "question_images": ["https://image.prepladder.com/content/G7YbMd2ghG3vOp0sbETq1713347243.png"], "explanation_images": [], "explanation": "<p>Correct Option C - Myring\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "How would you describe a fracture of the nasal septum that occurs both vertically and horizontally?", "options": [{"label": "A", "text": "Chevallet and Jarjaway fracture", "correct": true}, {"label": "B", "text": "Parade ground fracture", "correct": false}, {"label": "C", "text": "Tripod fracture", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "A. Chevallet and Jarjaway fracture", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/hYWb3t7MUicbAFduf1K11714027774.png", "https://image.prepladder.com/content/BczawTd4b0mk4ssWdumu1714027788.png"], "explanation": "<p>Correct Option A - Chevallet and Jarjaway fractu\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Jarjavay <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> (class 2)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Chevallet <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> (class 1)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Direction of blow</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lateral</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Frontal or fronto-lateral blow</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Direction of fracture</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Horizontal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vertical</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><img src=\"https://image.prepladder.com/content/hYWb3t7MUicbAFduf1K11714027774.png\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><img src=\"https://image.prepladder.com/content/BczawTd4b0mk4ssWdumu1714027788.png\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Where is the electrode placed in cochlear implant procedures?", "options": [{"label": "A", "text": "Round window", "correct": false}, {"label": "B", "text": "Oval window", "correct": false}, {"label": "C", "text": "Scala vestibule", "correct": false}, {"label": "D", "text": "Scala tympani", "correct": true}], "correct_answer": "D. Scala tympani", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/3BTCt76kFsQVeU0cNqOF1714380840.png"], "explanation": "<p>Correct Option D: S\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following signs suggests the presence of a high tracheostomy?", "options": [{"label": "A", "text": "Vocal cord palsy", "correct": false}, {"label": "B", "text": "Tracheomalacia", "correct": false}, {"label": "C", "text": "Foreign body obstruction", "correct": false}, {"label": "D", "text": "patients with total laryngectomy", "correct": true}], "correct_answer": "D. patients with total laryngectomy", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/zxREvnvk80lABrv0p62U1713502811.png"], "explanation": "<p>Correct Option D: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During pregnancy, in which trimester does acute fatty liver typically present most frequently?", "options": [{"label": "A", "text": "First trimester", "correct": false}, {"label": "B", "text": "Second trimester", "correct": false}, {"label": "C", "text": "Third trimester", "correct": true}, {"label": "D", "text": "Both a and b", "correct": false}], "correct_answer": "C. Third trimester", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C: Th\n<table>\n<tbody>\n<tr>\n<td colspan=\"2\">\n<p><strong>Swansea criteria of diagnosis of AFLP</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Clinical features</strong></p>\n<ul>\n<li>Vomiting</li>\n<li>Abdominal pain</li>\n<li>Encephalopathy</li>\n<li>Polydipsia/ polyuria</li>\n</ul>\n</td>\n<td>\n<p><strong>Laboratory</strong></p>\n<ul>\n<li>Bilirubin &gt; 0.8 mg/dL</li>\n<li>Glucose &lt; 72 mg/dL</li>\n<li>WBC &gt; 11000</li>\n<li>AST or ALK &gt; 42</li>\n<li>AKI or Cr &gt; 1.7 mg/dL</li>\n<li>Coagulopathy or PT &gt; 14 sec</li>\n<li>Urea &gt;340 mic.mol/L</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>USG</strong></p>\n<ul>\n<li>Ascites</li>\n</ul>\n</td>\n<td>\n<p><strong>Histology</strong></p>\n<ul>\n<li>Microvesicular steatosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\">\n<p>6 or more : AFLP diagnosis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the diagnosis for a 55-year-old woman who presents with abnormal uterine bleeding and undergoes a hysterectomy, resulting in the retrieval of the following specimen?", "options": [{"label": "A", "text": "Leiomyoma", "correct": true}, {"label": "B", "text": "Endometrial carcinoma", "correct": false}, {"label": "C", "text": "Endometrial polyp", "correct": false}, {"label": "D", "text": "Adenomyosis", "correct": false}], "correct_answer": "A. Leiomyoma", "question_images": ["https://image.prepladder.com/content/1kFAgqMUoHe3htJ25pxJ1691498079.PNG"], "explanation_images": [], "explanation": "<p>Correct Option A - L\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following ligament is responsible for maintaining the anteversion of the uterus during pregnancy?", "options": [{"label": "A", "text": "Round ligament", "correct": true}, {"label": "B", "text": "Cardinal ligament", "correct": false}, {"label": "C", "text": "Uterosacral ligament", "correct": false}, {"label": "D", "text": "Pubocervical ligament", "correct": false}], "correct_answer": "A. Round ligament", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ES1i75VnOY3FZvR4xfWA1715850390.png"], "explanation": "<p>Correct Option A: Round lig\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Quadruple testing is done during which of the following weeks of pregnancy?", "options": [{"label": "A", "text": "9-11 weeks", "correct": false}, {"label": "B", "text": "12-14 weeks", "correct": false}, {"label": "C", "text": "15-20 weeks", "correct": true}, {"label": "D", "text": "22-28 weeks", "correct": false}], "correct_answer": "C. 15-20 weeks", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C: 15-20 week\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"> </p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Median Values </strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Measured Values in Downs </strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\">HCG</p>\n</td>\n<td>\n<p style=\"text-align: center;\">x</p>\n</td>\n<td>\n<p style=\"text-align: center;\">High</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\">UE<sub>3</sub></p>\n</td>\n<td>\n<p style=\"text-align: center;\">y</p>\n</td>\n<td>\n<p style=\"text-align: center;\">Low</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\">FP</p>\n</td>\n<td>\n<p style=\"text-align: center;\">z</p>\n</td>\n<td>\n<p style=\"text-align: center;\">Low</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the recommended frequency of antenatal visits?", "options": [{"label": "A", "text": "12-14", "correct": true}, {"label": "B", "text": "6-8", "correct": false}, {"label": "C", "text": "7-9", "correct": false}, {"label": "D", "text": "10-11", "correct": false}], "correct_answer": "A. 12-14", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A: 12-14\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the recommended course of action for managing a pregnant woman who tests positive for HIV during her first trimester?", "options": [{"label": "A", "text": "Start ART immediately and continue till 6 weeks after delivery", "correct": false}, {"label": "B", "text": "Start ART after 1 st trimester and continue life-long", "correct": false}, {"label": "C", "text": "Start ART immediately and continue life-long", "correct": true}, {"label": "D", "text": "Start ART after 1 st trimester and continue till 6 weeks after delivery", "correct": false}], "correct_answer": "C. Start ART immediately and continue life-long", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C: Start ART immediately and continue life-long\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What determines the destiny of the Mullerian duct?", "options": [{"label": "A", "text": "X chromosome", "correct": false}, {"label": "B", "text": "Y chromosome", "correct": true}, {"label": "C", "text": "1 st chromosome", "correct": false}, {"label": "D", "text": "2 nd chromosome", "correct": false}], "correct_answer": "B. Y chromosome", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Y ch\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "After the insertion of a pessary, what is the initial action to assess its proper retention?", "options": [{"label": "A", "text": "Asking the patient to void and see if the pessary is in place", "correct": false}, {"label": "B", "text": "Seeing if the patient feels any discomfort, which means that the pessary is retained", "correct": false}, {"label": "C", "text": "Asking the patient to perform the Valsalva maneuver and see if the pessary is in place", "correct": true}, {"label": "D", "text": "Being able to admit two fingers between the ring and the pessary", "correct": false}], "correct_answer": "C. Asking the patient to perform the Valsalva maneuver and see if the pessary is in place", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Asking the patient to perform the Valsalva &lt;span class=\"customMeta\" data-dictid=\"220efc126c169277719138aa9a5537\"&gt;maneuver&lt;/span&gt; and see if the &lt;span class=\"customMeta\" data-dictid=\"e3571980751692777195feb15eb7d3\"&gt;pessary&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A pregnant women presents with obstructed labor and is grossly dehydrated. Investigations reveal fetal demise. What will be the management?", "options": [{"label": "A", "text": "Craniotomy", "correct": false}, {"label": "B", "text": "Decapitation", "correct": false}, {"label": "C", "text": "Cesarean section", "correct": true}, {"label": "D", "text": "Forceps extraction", "correct": false}], "correct_answer": "C. Cesarean section", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C: C\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "When is the most optimal period to determine the type of twin pregnancy using ultrasound?", "options": [{"label": "A", "text": "18-22 weeks", "correct": false}, {"label": "B", "text": "24-28 weeks", "correct": false}, {"label": "C", "text": "11-14 weeks", "correct": true}, {"label": "D", "text": "14-18 weeks", "correct": false}], "correct_answer": "C. 11-14 weeks", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/kei0rBvEIT20Dgz3ku0m1715850438.png"], "explanation": "<p>Correct Option C: 11-14 week\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements about the umbilical cord is not true?", "options": [{"label": "A", "text": "It has one artery and two veins", "correct": true}, {"label": "B", "text": "It contains a gelatinous substance called Wharton's jelly", "correct": false}, {"label": "C", "text": "Presence of a single umbilical artery is associated with congenital anomalies", "correct": false}, {"label": "D", "text": "Normal average umbilical cord length is 50-60 cms", "correct": false}], "correct_answer": "A. It has one artery and two veins", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A: It has one &lt;span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\"&gt;artery&lt;/span&gt; and two v\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Structure </strong></p>\n</td>\n<td>\n<p><strong>Physiological <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> </strong></p>\n</td>\n<td>\n<p><strong>Anatomical <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> </strong></p>\n</td>\n<td>\n<p><strong>Remnant </strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Ductus</p>\n</td>\n<td>\n<p>10-96 <span class=\"customMeta\" data-dictid=\"136c4bdd441692777189c5b2e976a0\">Hrs</span> after birth</p>\n</td>\n<td>\n<p>2-3 weeks of life</p>\n</td>\n<td>\n<p>Ligamentum venosum</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Ductus</p>\n</td>\n<td>\n<p>10-15 <span class=\"customMeta\" data-dictid=\"136c4bdd441692777189c5b2e976a0\">Hrs</span> after birth</p>\n</td>\n<td>\n<p>15-21 days (~3 months also)</p>\n</td>\n<td>\n<p>Ligamentum arteriosus</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Foramen ovale</p>\n</td>\n<td>\n<p>At birth</p>\n</td>\n<td>\n<p>3 months (within 1<sup>st</sup> year)</p>\n</td>\n<td>\n<p>Fossa ovalis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the statements below is incorrect regarding non-invasive prenatal testing?", "options": [{"label": "A", "text": "It uses cell-free circulating fetal DNA in the maternal serum", "correct": false}, {"label": "B", "text": "It is used for the diagnosis of trisomy 13,18 and 21", "correct": false}, {"label": "C", "text": "It can be performed after 10 weeks of gestation", "correct": false}, {"label": "D", "text": "It is done after the routine first trimester ultrasound assessment", "correct": true}], "correct_answer": "D. It is done after the routine first trimester ultrasound assessment", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following does not contribute to the development of secondary primary postpartum hemorrhage(PPH)?", "options": [{"label": "A", "text": "Retained cotyledon", "correct": false}, {"label": "B", "text": "Endometritis", "correct": false}, {"label": "C", "text": "Placental polyp", "correct": false}, {"label": "D", "text": "Placenta previa", "correct": true}], "correct_answer": "D. Placenta previa", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D: Placenta prev\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely diagnosis for a 16-year-old girl presenting with primary amenorrhea and the following characteristics? Normal stature Thelarche – absent FSH, LH – high Karyotype – 46 XX", "options": [{"label": "A", "text": "Testicular feminizing syndrome", "correct": false}, {"label": "B", "text": "Gonadal dysgenesis", "correct": true}, {"label": "C", "text": "Kallmann syndrome", "correct": false}, {"label": "D", "text": "Turner syndrome", "correct": false}], "correct_answer": "B. Gonadal dysgenesis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Gonadal dysg\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Fimbriectomy is also known as:", "options": [{"label": "A", "text": "Pomeroy technique", "correct": false}, {"label": "B", "text": "Uchida’s procedure", "correct": false}, {"label": "C", "text": "Kroener’s procedure", "correct": true}, {"label": "D", "text": "Irving’s procedure", "correct": false}], "correct_answer": "C. Kroener’s procedure", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/GxMrgwbbpfEqVkl2TsUf1687596941.png"], "explanation": "<p>Correct Option C - Kroener’s procedu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the subsequent options is unable to pass through the placenta? A. Iron B. Albumin C. Immunoglobulin M D. Immunoglobulin G", "options": [{"label": "A", "text": "A and B", "correct": false}, {"label": "B", "text": "Only C", "correct": false}, {"label": "C", "text": "B and C", "correct": true}, {"label": "D", "text": "C and D", "correct": false}], "correct_answer": "C. B and C", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C: B and C\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Substance</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Explanation</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Oxygen</p>\n</td>\n<td>\n<p>Oxygen is essential for <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> <span class=\"customMeta\" data-dictid=\"aea081ceb416927771976e2c17be74\">respiration</span> and can easily <span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\">diffuse</span> across the <span class=\"customMeta\" data-dictid=\"5276da31d11692777195f0e82f5e1d\">placenta</span> from the <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> bloodstream.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Nutrients (Glucose, <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">Amino</span> Acids)</p>\n</td>\n<td>\n<p>Important nutrients, including <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> and <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acids, are transported across the <span class=\"customMeta\" data-dictid=\"5276da31d11692777195f0e82f5e1d\">placenta</span> to provide nourishment for the developing fetus.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Immunoglobulin G (IgG)</p>\n</td>\n<td>\n<p>IgG antibodies, produced by the mother in response to infections or vaccinations, can cross the <span class=\"customMeta\" data-dictid=\"5276da31d11692777195f0e82f5e1d\">placenta</span> and provide <span class=\"customMeta\" data-dictid=\"c72d29ec4116927771942153c0d252\">passive</span> <span class=\"customMeta\" data-dictid=\"4f9ee631c21692777189b1e0cdc91c\">immunity</span> to the fetus.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Hormones (Thyroid Hormones, Estrogen, Progesterone)</p>\n</td>\n<td>\n<p>Certain hormones produced by the mother, such as <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> hormones, estrogen, and progesterone, can cross the <span class=\"customMeta\" data-dictid=\"5276da31d11692777195f0e82f5e1d\">placenta</span> and impact <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> development.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Carbon <span class=\"customMeta\" data-dictid=\"0bd01a042116927771868e3482910e\">Dioxide</span> (CO2)</p>\n</td>\n<td>\n<p>Carbon dioxide, a waste product produced by the fetus, can <span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\">diffuse</span> across the <span class=\"customMeta\" data-dictid=\"5276da31d11692777195f0e82f5e1d\">placenta</span> and be eliminated through the <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> bloodstream.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Medications and Drugs</p>\n</td>\n<td>\n<p>Various medications and drugs, both <span class=\"customMeta\" data-dictid=\"8dfaeedbf91692777200561b2b1d2f\">therapeutic</span> and recreational, have the potential to cross the <span class=\"customMeta\" data-dictid=\"5276da31d11692777195f0e82f5e1d\">placenta</span> and affect the fetus. It is important to consider the safety of medications during pregnancy.</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In which situations is dilatation and curettage considered inappropriate?", "options": [{"label": "A", "text": "Pelvic inflammatory disease", "correct": true}, {"label": "B", "text": "Ectopic pregnancy", "correct": false}, {"label": "C", "text": "Menstrual irregularities", "correct": false}, {"label": "D", "text": "Endometriosis", "correct": false}], "correct_answer": "A. Pelvic inflammatory disease", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A: Pelvic &lt;span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\"&gt;inflammatory&lt;/span&g\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Indications for <span class=\"customMeta\" data-dictid=\"29a08d8f9216927771869ed797367e\">Dilatation</span> and <span class=\"customMeta\" data-dictid=\"f857ee35331692777185a5895e53b5\">Curettage</span> (D&amp;C)</strong></p>\n</td>\n<td>\n<p><strong>Contraindications for <span class=\"customMeta\" data-dictid=\"29a08d8f9216927771869ed797367e\">Dilatation</span> and <span class=\"customMeta\" data-dictid=\"f857ee35331692777185a5895e53b5\">Curettage</span> (D&amp;C)</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Diagnosis and treatment of <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> bleeding</p>\n</td>\n<td>\n<p>Active <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> disease (PID)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Management of <span class=\"customMeta\" data-dictid=\"423516578d1692777192412d27cc61\">miscarriage</span> or incomplete abortion</p>\n</td>\n<td>\n<p>Active <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> infection or <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">genital</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infection</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Evaluation and treatment of endometrial hyperplasia</p>\n</td>\n<td>\n<p>Known or suspected pregnancy</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Removal of retained products of conception</p>\n</td>\n<td>\n<p>Severe <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">stenosis</span> or <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> cancer</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Investigation of <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> <span class=\"customMeta\" data-dictid=\"54e0888a6616927771945a99208287\">pathology</span> (e.g., polyps)</p>\n</td>\n<td>\n<p>Unstable <span class=\"customMeta\" data-dictid=\"f708e9dd3d1692777188de75c1834e\">hemodynamics</span> or significant medical comorbidities</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Control of <span class=\"customMeta\" data-dictid=\"3d885759d516927771966b84bfa470\">postpartum</span> hemorrhage</p>\n</td>\n<td>\n<p>Patient refusal or inability to tolerate the procedure</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What should be the next step in managing a 45-year-old woman who presents with post-coital bleeding and has a positive pap smear result?", "options": [{"label": "A", "text": "Colposcopy directed biopsy", "correct": true}, {"label": "B", "text": "Cone biopsy", "correct": false}, {"label": "C", "text": "Repeat pap smear", "correct": false}, {"label": "D", "text": "Hysterectomy", "correct": false}], "correct_answer": "A. Colposcopy directed biopsy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - C\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is observed in cases of superfecundation?", "options": [{"label": "A", "text": "Fertilization of 2 ova released at the same time by sperms released at single intercourse", "correct": false}, {"label": "B", "text": "Fertilization of 2 ova released in the same cycle by sperms released at intercourse on 2 different occasion", "correct": true}, {"label": "C", "text": "Both of the above", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "B. Fertilization of 2 ova released in the same cycle by sperms released at intercourse on 2 different occasion", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B: Fertilization of 2 &lt;span class=\"customMeta\" data-dictid=\"53c2b1ed0f1692777194d5ef066e39\"&gt;ova&lt;/span&gt; released in the same cycle by sperms released at &lt;span class=\"customMeta\" data-dictid=\"ad25936d1916927771900a1de2dd77\"&gt;intercourse&lt;/span&gt; on 2\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is false regarding peripartum cardiomyopathy?", "options": [{"label": "A", "text": "Development of cardiac failure within 5 months of delivery", "correct": false}, {"label": "B", "text": "Left ventricular end diastolic dimension more than 10 cm/m2 .", "correct": true}, {"label": "C", "text": "Absence of identifiable cause", "correct": false}, {"label": "D", "text": "Ejection fraction less than 45%", "correct": false}], "correct_answer": "B. Left ventricular end diastolic dimension more than 10 cm/m2 .", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the options below does not describe the mechanism of action of progesterone-only pills?", "options": [{"label": "A", "text": "Thicken the cervical mucus", "correct": false}, {"label": "B", "text": "Prevents ovulation", "correct": false}, {"label": "C", "text": "Kills the sperms in the cervical canal", "correct": true}, {"label": "D", "text": "Inhibits penetration of sperm", "correct": false}], "correct_answer": "C. Kills the sperms in the cervical canal", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/pgnuWLDQq4l7hQV9LfTp1714995452.png"], "explanation": "<p>Correct Option C - Kills the sperms in the &lt;span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\"&gt;cervical&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which one of the following is not regarded as a contributing factor for a pregnancy with an increased risk?", "options": [{"label": "A", "text": "Obesity", "correct": false}, {"label": "B", "text": "Polyhydramnios", "correct": false}, {"label": "C", "text": "Anaemia", "correct": false}, {"label": "D", "text": "Previous manual removal of placenta", "correct": true}], "correct_answer": "D. Previous manual removal of placenta", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/pD8Pv6AucLGq1JKub4Pa1687598549.png"], "explanation": "<p>Correct Option D: Previous manual remov\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Parameter</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Points</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\">Fetal movement</p>\n</td>\n<td>\n<p style=\"text-align: center;\">2</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\">Fetal tone</p>\n</td>\n<td>\n<p style=\"text-align: center;\">2</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\">Fetal breathing</p>\n</td>\n<td>\n<p style=\"text-align: center;\">2</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\">Reactive NST</p>\n</td>\n<td>\n<p style=\"text-align: center;\">2</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\">AFI</p>\n</td>\n<td>\n<p style=\"text-align: center;\">2</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following conditions may result from chronic pelvic inflammation?", "options": [{"label": "A", "text": "Pyometra", "correct": true}, {"label": "B", "text": "Uterine polyposis", "correct": false}, {"label": "C", "text": "Pseudocyesis", "correct": false}, {"label": "D", "text": "Endometrial hyperplasia", "correct": false}], "correct_answer": "A. Pyometra", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - P\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most frequent manifestation of postpartum nerve injury among the options provided?", "options": [{"label": "A", "text": "Facial palsy", "correct": false}, {"label": "B", "text": "Wrist drop", "correct": false}, {"label": "C", "text": "Foot drop", "correct": true}, {"label": "D", "text": "Claw hand", "correct": false}], "correct_answer": "C. Foot drop", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C: F\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is altered in the thyroid profile throughout pregnancy?", "options": [{"label": "A", "text": "Free T3 level", "correct": false}, {"label": "B", "text": "Free T4 level", "correct": false}, {"label": "C", "text": "Total T3 level", "correct": true}, {"label": "D", "text": "TSH level", "correct": false}], "correct_answer": "C. Total T3 level", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which is the first organ to putrefy ?", "options": [{"label": "A", "text": "Brain", "correct": true}, {"label": "B", "text": "Heart", "correct": false}, {"label": "C", "text": "Kidney", "correct": false}, {"label": "D", "text": "Prostate", "correct": false}], "correct_answer": "A. Brain", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - B\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which article in the constitution does not pertain to children ?", "options": [{"label": "A", "text": "Article21A", "correct": false}, {"label": "B", "text": "Article24", "correct": false}, {"label": "C", "text": "Article45", "correct": false}, {"label": "D", "text": "Article 42", "correct": true}], "correct_answer": "D. Article 42", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - A\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Article Number</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Article Title and Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Article 21A</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Right to Education</strong>: The State shall provide free and compulsory education to all children in the age group of 6 to 14 years.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Article 24</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Prohibition of employment of children in hazardous occupations or engaged in any <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of forced labor.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Article 45</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Provision of<strong> early childhood care and education for children </strong>below the age of six years.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In which Section does McNaughten's rule fall under?", "options": [{"label": "A", "text": "Section 83 of CrPC", "correct": false}, {"label": "B", "text": "Section 84 of IPC", "correct": true}, {"label": "C", "text": "Section 184 of IPC", "correct": false}, {"label": "D", "text": "Section 184 of CrPC", "correct": false}], "correct_answer": "B. Section 84 of IPC", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B: Section 84 of IPC\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Luminescent stools are associated with which of the following?", "options": [{"label": "A", "text": "Mercury", "correct": false}, {"label": "B", "text": "Cadmium", "correct": false}, {"label": "C", "text": "Phosphorus", "correct": true}, {"label": "D", "text": "Oxalic acid", "correct": false}], "correct_answer": "C. Phosphorus", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Phosphoru\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following poisons present with bluish discoloration of the stomach mucosa on post mortem examination ?", "options": [{"label": "A", "text": "Oxalic acid", "correct": false}, {"label": "B", "text": "Sodium amytal", "correct": true}, {"label": "C", "text": "Soneryl", "correct": false}, {"label": "D", "text": "Arsenic", "correct": false}], "correct_answer": "B. Sodium amytal", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Sodiu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Saturnine gout is seen in:", "options": [{"label": "A", "text": "Lead poisoning", "correct": true}, {"label": "B", "text": "Cadmium poisoning", "correct": false}, {"label": "C", "text": "Beryllium poisoning", "correct": false}, {"label": "D", "text": "Mercury poisoning", "correct": false}], "correct_answer": "A. Lead poisoning", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Lead poisoning\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "At what age, basiocciput fuses with basisphenoid ?", "options": [{"label": "A", "text": "18-22 years", "correct": true}, {"label": "B", "text": "22-25 years", "correct": false}, {"label": "C", "text": "14-16 years", "correct": false}, {"label": "D", "text": "12-14 years", "correct": false}], "correct_answer": "A. 18-22 years", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - 18-22\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Edmond Locard is most famous for?", "options": [{"label": "A", "text": "Study of fingerprints", "correct": false}, {"label": "B", "text": "Theory of exchange", "correct": true}, {"label": "C", "text": "Stature estimation", "correct": false}, {"label": "D", "text": "Forensic ballistics", "correct": false}], "correct_answer": "B. Theory of exchange", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Theory of exchang\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the odor of the mummified body ?", "options": [{"label": "A", "text": "Odorless", "correct": true}, {"label": "B", "text": "Pungent", "correct": false}, {"label": "C", "text": "Putrid", "correct": false}, {"label": "D", "text": "Offensive", "correct": false}], "correct_answer": "A. Odorless", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/s3Jme5K3JX7vD4ihHLTZ1715330495.png"], "explanation": "<p>Correct Option A: O\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which metallic poisoning Mimics cholera?", "options": [{"label": "A", "text": "Arsenic", "correct": true}, {"label": "B", "text": "Chromium", "correct": false}, {"label": "C", "text": "Mercury", "correct": false}, {"label": "D", "text": "Lead", "correct": false}], "correct_answer": "A. Arsenic", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which option provides the most accurate description of a posthumous child ?", "options": [{"label": "A", "text": "Delivery of a macerated fetus", "correct": false}, {"label": "B", "text": "Child is delivered after death of biological father", "correct": true}, {"label": "C", "text": "Child is born to an unmarried couple", "correct": false}, {"label": "D", "text": "Child is abandoned by the parents", "correct": false}], "correct_answer": "B. Child is delivered after death of biological father", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Child is delivered after death of biological fath\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following conditions does the 40-year-old woman, who was involved in a car accident 2 months ago, experience when she wakes up screaming at night due to recurring nightmares of the same incident ?", "options": [{"label": "A", "text": "Acute stress reaction", "correct": false}, {"label": "B", "text": "Adjustment disorder", "correct": false}, {"label": "C", "text": "Mania", "correct": false}, {"label": "D", "text": "Post- traumatic stress disorder", "correct": true}], "correct_answer": "D. Post- traumatic stress disorder", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Post- &lt;span class=\"customMeta\" data-dictid=\"18034e0517169277720002aaa66d36\"&gt;traumatic&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following characteristics provides stronger evidence in support of delirium ?", "options": [{"label": "A", "text": "Occurs gradually over a period of time", "correct": false}, {"label": "B", "text": "Fluctuating course", "correct": true}, {"label": "C", "text": "Preserved consciousness", "correct": false}, {"label": "D", "text": "Commonly associated with auditory hallucinations", "correct": false}], "correct_answer": "B. Fluctuating course", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Fluctuating cou\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "How can we describe the emotional release and discharge that occurs when a person consciously relieves a repressed painful experienc e?", "options": [{"label": "A", "text": "Catharsis", "correct": false}, {"label": "B", "text": "Abreaction", "correct": true}, {"label": "C", "text": "Venting out", "correct": false}, {"label": "D", "text": "Guided relaxation", "correct": false}], "correct_answer": "B. Abreaction", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "According to the revision of DSM-5 by the American Psychiatric Association, what is the current term used to refer to ' mental retardation '?", "options": [{"label": "A", "text": "Feeble mindedness", "correct": false}, {"label": "B", "text": "Mental subnormality", "correct": false}, {"label": "C", "text": "Intellectual disability", "correct": true}, {"label": "D", "text": "Intellectually challenged", "correct": false}], "correct_answer": "C. Intellectual disability", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Intellectu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the purpose of utilizing the confusion assessment test?", "options": [{"label": "A", "text": "Dementia", "correct": false}, {"label": "B", "text": "Depression", "correct": false}, {"label": "C", "text": "Delirium", "correct": true}, {"label": "D", "text": "Schizophrenia", "correct": false}], "correct_answer": "C. Delirium", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Deliriu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which disorder was previously known as Minimal brain dysfunction ?", "options": [{"label": "A", "text": "Dyslexia", "correct": false}, {"label": "B", "text": "Attention deficit/hyperactivity disorder", "correct": true}, {"label": "C", "text": "Mental subnormality", "correct": false}, {"label": "D", "text": "Oligophrenia", "correct": false}], "correct_answer": "B. Attention deficit/hyperactivity disorder", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Attention deficit/hyperactiv\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "For which of the following conditions is the squeeze technique utilized ?", "options": [{"label": "A", "text": "Retrograde ejaculation", "correct": false}, {"label": "B", "text": "Erectile dysfunction", "correct": false}, {"label": "C", "text": "Premature ejaculation", "correct": true}, {"label": "D", "text": "Painful ejaculation", "correct": false}], "correct_answer": "C. Premature ejaculation", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"84f13673191692777196762b18e036\"&gt;Premature&lt;/span&gt; ejacu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following disorders may present with symptoms similar to Addison's disease ?", "options": [{"label": "A", "text": "Depression", "correct": true}, {"label": "B", "text": "Generalised anxiety disorder", "correct": false}, {"label": "C", "text": "Bipolar disorder", "correct": false}, {"label": "D", "text": "Panic disorder", "correct": false}], "correct_answer": "A. Depression", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - D\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the subsequent options is not classified as an obsessive-compulsive disorder (OCD) related ailment?", "options": [{"label": "A", "text": "Hair pulling disorder", "correct": false}, {"label": "B", "text": "Temper tantrums", "correct": true}, {"label": "C", "text": "Hoarding disorder", "correct": false}, {"label": "D", "text": "Skin picking", "correct": false}], "correct_answer": "B. Temper tantrums", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Temper tantru\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Most common obsessions </strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Compulsions </strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Contamination (mc)</p>\n</td>\n<td>\n<p>Checking (mc)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Pathological doubt (2<sup>nd</sup> mc)</p>\n</td>\n<td>\n<p>Washing (2<sup>nd</sup> mc)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Somatic</p>\n</td>\n<td>\n<p>Counting</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Need for symmetry</p>\n</td>\n<td>\n<p>Need to ask or confess</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Aggressive</p>\n</td>\n<td>\n<p>Symmetry &amp; precision</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Sexual</p>\n</td>\n<td>\n<p>Multiple</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Multiple</p>\n</td>\n<td>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is false regarding Alzheimer's disease?", "options": [{"label": "A", "text": "Intracellular neurofibrillary tangles are seen", "correct": false}, {"label": "B", "text": "Neuritic plaques made of beta amyloid are found", "correct": false}, {"label": "C", "text": "Nucleus of Meynert is not affected", "correct": true}, {"label": "D", "text": "Short term memory is affected", "correct": false}], "correct_answer": "C. Nucleus of Meynert is not affected", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"ff628904401692777193c8a9f9159e\"&gt;Nucleus&lt;/span&gt; of M\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following are indications for surgical intervention in abdominal aortic aneurysms ?", "options": [{"label": "A", "text": "Size more than 5.5 cm in males", "correct": false}, {"label": "B", "text": "Size more than 5 cm in females", "correct": false}, {"label": "C", "text": "Expansion of &amp;gt;0.5 cm within 6 months", "correct": false}, {"label": "D", "text": "All the above", "correct": true}], "correct_answer": "D. All the above", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - All the abov\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The following image shows the retrograde ureteropyelogram of a patient with loin pain. What is the most probable clinical diagnosis ?", "options": [{"label": "A", "text": "Hydronephrosis", "correct": true}, {"label": "B", "text": "Duplex kidney", "correct": false}, {"label": "C", "text": "Renal carcinoma", "correct": false}, {"label": "D", "text": "Renal stone", "correct": false}], "correct_answer": "A. Hydronephrosis", "question_images": ["https://image.prepladder.com/content/shKqhiy8h33nGigW7e581691498141.png"], "explanation_images": [], "explanation": "<p>Correct Option A - Hydroneph\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following conditions is caused by the infection of protease ?", "options": [{"label": "A", "text": "Uric acid", "correct": false}, {"label": "B", "text": "Ammonium magnesium phosphate", "correct": true}, {"label": "C", "text": "Struvite", "correct": false}, {"label": "D", "text": "Calcium oxalate", "correct": false}], "correct_answer": "B. Ammonium magnesium phosphate", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Ammonium &lt;span class=\"customMeta\" data-dictid=\"4d7ed0baae169277719199f6e9ab7b\"&gt;magnesium&lt;/span&gt; phosph\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the Glasgow Coma Score of a patient who is making Incomprehensible sounds, opens their eyes in response to painful stimuli and flexes one limb in response to painful stimuli.", "options": [{"label": "A", "text": "9", "correct": false}, {"label": "B", "text": "15", "correct": false}, {"label": "C", "text": "10", "correct": false}, {"label": "D", "text": "8", "correct": true}], "correct_answer": "D. 8", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\">\n<tbody>\n<tr>\n<td colspan=\"2\">\n<p><strong>Eye Opening </strong></p>\n</td>\n<td colspan=\"2\">\n<p><strong>Verbal response </strong></p>\n<p><strong>(Mnemonics: “One confused word sounds nowhere\")</strong></p>\n</td>\n<td colspan=\"2\">\n<p><strong>Motor response (best) (Mnemonics: “Obey localities with <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> and extension\")</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>E4</strong></p>\n</td>\n<td>\n<p>Spontaneous</p>\n</td>\n<td>\n<p><strong>V5</strong></p>\n</td>\n<td>\n<p>Oriented</p>\n</td>\n<td>\n<p><strong>M6 </strong></p>\n</td>\n<td>\n<p>Patient obeys command</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>E3</strong></p>\n</td>\n<td>\n<p>To loud voice (speech)</p>\n</td>\n<td>\n<p><strong>V4 </strong></p>\n</td>\n<td>\n<p>Disoriented /confused</p>\n</td>\n<td>\n<p><strong>M5</strong></p>\n</td>\n<td>\n<p>Localizes pain</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>E2</strong></p>\n</td>\n<td>\n<p>To pain (pressure)</p>\n</td>\n<td>\n<p><strong>V3</strong></p>\n</td>\n<td>\n<p>Inappropriate (words)</p>\n</td>\n<td>\n<p><strong>M4</strong></p>\n</td>\n<td>\n<p>Withdrawal to pain (there is normal flexion)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>E1</strong></p>\n</td>\n<td>\n<p>No response</p>\n</td>\n<td>\n<p><strong>V2</strong></p>\n</td>\n<td>\n<p>Incomprehensible (sounds)</p>\n</td>\n<td>\n<p><strong>M3</strong></p>\n</td>\n<td>\n<p>Abnormal <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> posturing</p>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<p> </p>\n</td>\n<td>\n<p><strong>V1</strong></p>\n</td>\n<td>\n<p>No response</p>\n</td>\n<td>\n<p><strong>M2</strong></p>\n</td>\n<td>\n<p>Extension posturing</p>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<p> </p>\n</td>\n<td>\n<p> </p>\n</td>\n<td>\n<p> </p>\n</td>\n<td>\n<p><strong>M1</strong></p>\n</td>\n<td>\n<p>No response</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with a painless neck swelling . The histology of the tissue is as given in the image below. What is the diagnosis?", "options": [{"label": "A", "text": "Medullary carcinoma", "correct": false}, {"label": "B", "text": "NHL", "correct": false}, {"label": "C", "text": "Graves disease", "correct": false}, {"label": "D", "text": "Hashimoto’s thyroiditis", "correct": true}], "correct_answer": "D. Hashimoto’s thyroiditis", "question_images": ["https://image.prepladder.com/content/wjYrB5Pdf4YERxyru87k1711958369.png"], "explanation_images": ["https://image.prepladder.com/content/SDzW160sbePHJRYUxufJ1711959140.png", "https://image.prepladder.com/content/VquIvV08xHBhL2gXcSKz1711958663.png", "https://image.prepladder.com/content/PnOZiac9G1Dpn2jslwy21711958912.png", "https://image.prepladder.com/content/wjYrB5Pdf4YERxyru87k1711958369.png", "https://image.prepladder.com/content/SDzW160sbePHJRYUxufJ1711959140.png"], "explanation": "<p>Correct Option D - Hashimoto’s Th\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old mal e patient who presented with scrotal swelling underwent an orchidectomy. The image below shows the histopathology findings . What is your diagnosis?", "options": [{"label": "A", "text": "Seminoma", "correct": true}, {"label": "B", "text": "Yolk-sac tumor", "correct": false}, {"label": "C", "text": "Embryonal cell carcinoma", "correct": false}, {"label": "D", "text": "Teratoma", "correct": false}], "correct_answer": "A. Seminoma", "question_images": ["https://image.prepladder.com/content/2cSSQrm86FKrKYDmwTE11691498278.png"], "explanation_images": [], "explanation": "<p>Correct Option A - S\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During the surgical procedure for an inguinal hernia in a child, the surgeon observes that the bowel is necrotic . Regarding the resection and anastomosis of the bowel, which statement is accurate?", "options": [{"label": "A", "text": "The surgeon must use chromic catgut", "correct": false}, {"label": "B", "text": "The surgeon must not include the submucosa in the sutures", "correct": false}, {"label": "C", "text": "The surgeon must use the single-layer, extramucosal suture technique", "correct": true}, {"label": "D", "text": "The surgeon must use the single-layer seromuscular suture technique", "correct": false}], "correct_answer": "C. The surgeon must use the single-layer, extramucosal suture technique", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - The surgeon must use the single-layer, extramucosal &lt;span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\"&gt;suture&lt;/span&gt; techniqu\n<p><strong>References:</strong></p>\n<ul><li>↳ Technique choice depends on bowel condition, location, surgeon preference, and patient factors.</li><li>↳ Single-Layer, Extramucosal Suture: Outer bowel layers are sutured, excluding the inner mucosal layer. Reduces leakage risk, especially in necrotic bowel cases.</li><li>↳ Double-Layer Technique: Both seromuscular and mucosal layers are sutured separately, offering added reinforcement and widely used in anastomosis.</li></u\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A lady has a reddish, firm nodule on her chest that has not grown in size. The histopathological image is shown below. What is the diagnosis?", "options": [{"label": "A", "text": "Lipoma", "correct": false}, {"label": "B", "text": "Fibroadenoma", "correct": false}, {"label": "C", "text": "Nevus", "correct": false}, {"label": "D", "text": "Hemangioma", "correct": true}], "correct_answer": "D. Hemangioma", "question_images": ["https://image.prepladder.com/content/ohhes3wIUyfuRjC62Tj41714479502.png"], "explanation_images": [], "explanation": "<p>Correct Option D - Hemang\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which is the most common organism causing acute bacterial prostatitis ?", "options": [{"label": "A", "text": "Enterococcus", "correct": false}, {"label": "B", "text": "Proteus", "correct": false}, {"label": "C", "text": "Streptococcus Agalacticia", "correct": false}, {"label": "D", "text": "E.coli", "correct": true}], "correct_answer": "D. E.coli", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - E.\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the OPD, a 35-year-old male presented with concerns of passing dark-colored stools . Following an endoscopy, the patient was diagnosed with an upper gastrointestinal (GI) bleed. Which anatomical structure serves as a distinguishing point to differentiate it from a lower GI bleed?", "options": [{"label": "A", "text": "Ampulla of Vater", "correct": false}, {"label": "B", "text": "Ligament of Treitz", "correct": true}, {"label": "C", "text": "Superior duodenal flexure", "correct": false}, {"label": "D", "text": "IIeocaecal junction", "correct": false}], "correct_answer": "B. Ligament of Treitz", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Ligament of Treitz:</p>\n<p><strong>References:</strong></p>\n<ul><li>↳ The Ligament of Treitz, also known as the suspensory muscle of the duodenum, is a fibrous band located at the junction between the duodenum (the first part of the small intestine) and the jejunum (the second part of the small intestine).</li><li>↳ This anatomical landmark serves as a useful reference point for distinguishing between upper and lower GI bleeding.</li><li>↳ Incorrect Options:</li><li>↳ Incorrect Options:</li><li>↳ Option A - Ampulla of Vater: The Ampulla of Vater is the site where the common bile duct and the pancreatic duct join and enter the duodenum.</li><li>↳ Option A - Ampulla of Vater:</li><li>↳ Option C - Superior duodenal flexure: The superior duodenal flexure refers to the curved segment of the duodenum, where it transitions from the descending part to the horizontal part.</li><li>↳ Option C - Superior duodenal flexure:</li><li>↳ Option D - Ileocecal junction: The ileocecal junction is the point where the small intestine (ileum) connects to the large intestine (cecum).</li><li>↳ Option D - Ileocecal junction:</li></u\n<p><strong>References:</strong></p>\n<ul><li>↳ It is a fibrous band connecting the fourth part of the duodenum to the diaphragm, situated at the level of the duodenojejunal flexure.</li><li>↳ Used to differentiate between the upper and lower gastrointestinal tract, marking the transition between the proximal (upper) small intestine (duodenum) and the distal (lower) small intestine (jejunum).</li><li>↳ Important in diagnosing and classifying gastrointestinal bleeding. It helps differentiate upper GI bleeding (above the Ligament of Treitz) from lower GI bleeding (below it).</li><li>↳ A crucial landmark in various gastrointestinal surgeries, including gastric bypass and small intestine resection. Surgeons use it as a reference point to identify the duodenojejunal junction and plan interventions accordingly.</li></u\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most suitable graft for performing a femoropopliteal bypass procedure?", "options": [{"label": "A", "text": "Dacron", "correct": false}, {"label": "B", "text": "Great saphenous vein", "correct": true}, {"label": "C", "text": "Polytetrafluoroethylene", "correct": false}, {"label": "D", "text": "Short saphenous vein", "correct": false}], "correct_answer": "B. Great saphenous vein", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Great saphenous v\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most common cause of chronic pancreatitis ?", "options": [{"label": "A", "text": "Gallstones", "correct": false}, {"label": "B", "text": "Alcohol", "correct": true}, {"label": "C", "text": "Autoimmune", "correct": false}, {"label": "D", "text": "Drugs", "correct": false}], "correct_answer": "B. Alcohol", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Alcoh\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the name of the procedure in which a probe is inserted into the duct from which the discharge is emerging, followed by making a tennis racquet incision and dissecting the flap to reach the duct, and finally excising the duct?", "options": [{"label": "A", "text": "Macrodochectomy", "correct": false}, {"label": "B", "text": "Microdochectomy", "correct": true}, {"label": "C", "text": "Cone excision", "correct": false}, {"label": "D", "text": "Wide excision of the lactiferous duct", "correct": false}], "correct_answer": "B. Microdochectomy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Microdoch\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is a valid statement regarding chromic catgut?", "options": [{"label": "A", "text": "It is made from cat gut", "correct": false}, {"label": "B", "text": "It is made from rabbit gut", "correct": false}, {"label": "C", "text": "It is absorbed by enzymatic degradation and macrophage phagocytosis", "correct": true}, {"label": "D", "text": "It is tanned with nickel salts to improve handling and to resist degradation in tissue", "correct": false}], "correct_answer": "C. It is absorbed by enzymatic degradation and macrophage phagocytosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - It is absorbed by &lt;span class=\"customMeta\" data-dictid=\"11d4157da4169277718762144a4fe7\"&gt;enzymatic&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"d395f610461692777185cbe8b8806d\"&gt;degradation&lt;/span&gt; and &lt;span class=\"customMeta\" data-dictid=\"2748357f451692777191377abbe2a6\"&gt;macrophage&lt;/span&gt; phag\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Please identify the instrument shown in the image provided:", "options": [{"label": "A", "text": "Daever’s retractor", "correct": false}, {"label": "B", "text": "Morris retractor", "correct": true}, {"label": "C", "text": "Czerney’s retractor", "correct": false}, {"label": "D", "text": "Double hook retractor", "correct": false}], "correct_answer": "B. Morris retractor", "question_images": ["https://image.prepladder.com/content/3Wef71giku6UyuCV5Mxg1691498388.png"], "explanation_images": ["https://image.prepladder.com/content/fgPX83Oacsa6rdGixukf1687758625.png", "https://image.prepladder.com/content/jkwBO45Nxwg4Rm2wza0R1687758631.png", "https://image.prepladder.com/content/mkGJ7u7l1xYlSuWGy1u51687758636.png", "https://image.prepladder.com/content/mw7iURTQAivUbUOM9TZF1687758641.png"], "explanation": "<p>Correct Option B - M\n<table>\n<tbody>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<p><strong>Langenbeck’s </strong></p>\n</td>\n<td>\n<p><strong>Morris </strong></p>\n</td>\n<td>\n<p><strong>Doyen’s </strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Handle </strong></p>\n</td>\n<td>\n<p>Fenestrated</p>\n</td>\n<td>\n<p>Fenestrated</p>\n</td>\n<td>\n<p>No fenestration</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Blade </strong></p>\n</td>\n<td>\n<p>Wide</p>\n</td>\n<td>\n<p>Wider &amp; more curved</p>\n</td>\n<td>\n<p>More curved inside</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Tip </strong></p>\n</td>\n<td>\n<p> </p>\n</td>\n<td>\n<p>More curved</p>\n</td>\n<td>\n<p>More curved</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Extra mammary Paget’s disease is commonly seen in the:", "options": [{"label": "A", "text": "Vulva", "correct": true}, {"label": "B", "text": "Vagina", "correct": false}, {"label": "C", "text": "Uterus", "correct": false}, {"label": "D", "text": "Cervix", "correct": false}], "correct_answer": "A. Vulva", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Vulva: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most effective technique for procuring tissue for the purpose of diagnosing pancreatic carcinoma?", "options": [{"label": "A", "text": "Transgastric FNAC guided by endoscopic ultrasound", "correct": true}, {"label": "B", "text": "MRI - guided biopsy", "correct": false}, {"label": "C", "text": "Laparoscopic - guided biopsy", "correct": false}, {"label": "D", "text": "Percutaneous transperitoneal biopsy", "correct": false}], "correct_answer": "A. Transgastric FNAC guided by endoscopic ultrasound", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Transgastric FNAC guided by &lt;span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\"&gt;endoscopic&lt;/span&gt; ultrasou\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An abdominal mass in a patient with congenital hypertrophic pyloric stenosis is best seen _________:", "options": [{"label": "A", "text": "During feeding", "correct": true}, {"label": "B", "text": "Soon after birth", "correct": false}, {"label": "C", "text": "During palpation, over the left hypochondirum", "correct": false}, {"label": "D", "text": "During palpation, over the epigastrium", "correct": false}], "correct_answer": "A. During feeding", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - During feeding\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During the procedure of performing a fasciotomy to treat compartment syndrome , the incision is made through the following layers:", "options": [{"label": "A", "text": "Skin and Subcutaneous tissue", "correct": false}, {"label": "B", "text": "Skin, Subcutaneous tissue, Superficial fascia", "correct": false}, {"label": "C", "text": "Skin, Subcutaneous tissue, Superficial fascia and Deep fascia", "correct": true}, {"label": "D", "text": "Skin, Subcutaneous tissue, Superficial fascia, Deep fascia and a few muscular fibres", "correct": false}], "correct_answer": "C. Skin, Subcutaneous tissue, Superficial fascia and Deep fascia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Skin, &lt;span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\"&gt;Subcutaneous&lt;/span&gt; tissue, &lt;span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\"&gt;Superficial&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"65483c739e169277720294dce50377\"&gt;fascia&lt;/span&gt; and D\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the accurate statement regarding Crohn's disease?", "options": [{"label": "A", "text": "For effective treatment of a Crohn’s mass, only antibiotics are prescribed", "correct": false}, {"label": "B", "text": "Symptomatic relapse after surgery is not related to the presence of disease during resection", "correct": true}, {"label": "C", "text": "The proximal caecum is most commonly involved in Crohn’s disease", "correct": false}, {"label": "D", "text": "On endoscopic examination continuous lesions are visualised, which are diagnostic of Crohn’s disease", "correct": false}], "correct_answer": "B. Symptomatic relapse after surgery is not related to the presence of disease during resection", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Symptomatic &lt;span class=\"customMeta\" data-dictid=\"b4b361c37616927771979541177070\"&gt;relapse&lt;/span&gt; after surgery is not related to the presence of disease during\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the earliest indication of Crohn's disease among the options provided?", "options": [{"label": "A", "text": "Cobblestone appearance", "correct": false}, {"label": "B", "text": "Deep fissured ulcers", "correct": false}, {"label": "C", "text": "Rose-thorn appearance", "correct": false}, {"label": "D", "text": "Aphthous ulcers", "correct": true}], "correct_answer": "D. Aphthous ulcers", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Aphthous u\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not included in the Van Nuys grading system for ductal carcinoma in situ?", "options": [{"label": "A", "text": "Age of the patient", "correct": false}, {"label": "B", "text": "Size of the tumor", "correct": false}, {"label": "C", "text": "Hormone receptor staining", "correct": true}, {"label": "D", "text": "Comedo-type necrosis", "correct": false}], "correct_answer": "C. Hormone receptor staining", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Hormone &lt;span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\"&gt;receptor&lt;/span&gt; staining:</p>\n<table>\n<thead>\n<tr>\n<td colspan=\"1\" rowspan=\"1\" style=\"vertical-align:bottom\"><strong>Score</strong></td>\n<td colspan=\"1\" rowspan=\"1\" style=\"text-align:center; vertical-align:bottom\">1</td>\n<td colspan=\"1\" rowspan=\"1\" style=\"text-align:center; vertical-align:bottom\">2</td>\n<td colspan=\"1\" rowspan=\"1\" style=\"text-align:center; vertical-align:bottom\">3</td>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td colspan=\"1\" rowspan=\"1\"><strong>Size</strong></td>\n<td colspan=\"1\" rowspan=\"1\" style=\"text-align:center\">≤15 mm</td>\n<td colspan=\"1\" rowspan=\"1\" style=\"text-align:center\">16–40</td>\n<td colspan=\"1\" rowspan=\"1\" style=\"text-align:center\">&gt;40</td>\n</tr>\n<tr>\n<td colspan=\"1\" rowspan=\"1\"><strong>Margin</strong></td>\n<td colspan=\"1\" rowspan=\"1\" style=\"text-align:center\">≥10 mm</td>\n<td colspan=\"1\" rowspan=\"1\" style=\"text-align:center\">1–9</td>\n<td colspan=\"1\" rowspan=\"1\" style=\"text-align:center\">&lt;1</td>\n</tr>\n<tr>\n<td colspan=\"1\" rowspan=\"1\"><strong>Class</strong></td>\n<td colspan=\"1\" rowspan=\"1\" style=\"text-align:center\">Grade 1/2 without necrosis</td>\n<td colspan=\"1\" rowspan=\"1\" style=\"text-align:center\">Grade 1/2 with necrosis</td>\n<td colspan=\"1\" rowspan=\"1\" style=\"text-align:center\">Grade 3</td>\n</tr>\n<tr>\n<td colspan=\"1\" rowspan=\"1\"><strong>Age</strong></td>\n<td colspan=\"1\" rowspan=\"1\" style=\"text-align:center\">&gt;60</td>\n<td colspan=\"1\" rowspan=\"1\" style=\"text-align:center\">40–60</td>\n<td colspan=\"1\" rowspan=\"1\" style=\"text-align:center\">&lt;40</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements are true with regards to a keloid scar ?", "options": [{"label": "A", "text": "The extant does not cross the wound margins", "correct": false}, {"label": "B", "text": "Wide excision of the keloid scar prevents recurrence", "correct": false}, {"label": "C", "text": "Histopathology of a keloid scar shows reduced collagen and increased vascularity", "correct": false}, {"label": "D", "text": "A keloid scar forms due to increase in the level of growth factors", "correct": true}], "correct_answer": "D. A keloid scar forms due to increase in the level of growth factors", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - A &lt;span class=\"customMeta\" data-dictid=\"76020bd1501692777190627edf191b\"&gt;keloid&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"561a199cce1692777198225706434c\"&gt;scar&lt;/span&gt; forms due to increase in the level of growth\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Heller’s operation i s done for _______:", "options": [{"label": "A", "text": "Achalasia cardia", "correct": true}, {"label": "B", "text": "Carcinoma esophagus", "correct": false}, {"label": "C", "text": "Esophageal stricture", "correct": false}, {"label": "D", "text": "Hypertrophic pyloric stenosis", "correct": false}], "correct_answer": "A. Achalasia cardia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Ach\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements about Barrett's esophagus is incorrect?", "options": [{"label": "A", "text": "It is the intestinal metaplasia of esophagus", "correct": false}, {"label": "B", "text": "Mucus secreting foveolar cells are characteristic", "correct": true}, {"label": "C", "text": "Alician blue is used in the staining of biopsy specimen", "correct": false}, {"label": "D", "text": "Adenocarcinoma of O-G junction is a complication", "correct": false}], "correct_answer": "B. Mucus secreting foveolar cells are characteristic", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Mucus-secreting foveolar cells are ch\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the calculation method for determining the modified shock index?", "options": [{"label": "A", "text": "HR/SBP", "correct": false}, {"label": "B", "text": "HR/DBP", "correct": false}, {"label": "C", "text": "HR/MAP", "correct": true}, {"label": "D", "text": "PR/SBP", "correct": false}], "correct_answer": "C. HR/MAP", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - HR/MAP\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "How do the muscle relaxants in the curare group work?", "options": [{"label": "A", "text": "Persistently depolarizing at neuromuscular junction", "correct": false}, {"label": "B", "text": "Competitively blocking the binding of ACH to its receptors", "correct": true}, {"label": "C", "text": "Repetitive stimulation of ACh receptors on muscle endplate", "correct": false}, {"label": "D", "text": "Inhibiting the calcium channels on presynaptic membrane", "correct": false}], "correct_answer": "B. Competitively blocking the binding of ACH to its receptors", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Aminosteroids</strong></p>\n</td>\n<td>\n<p><strong>Benzylisoquinolines</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>1. Pancuronium (long acting)</p>\n<p>2. Pipercuronium (long acting)</p>\n<p>3. Vecuronium (intermediate acting)</p>\n<p>4. Rocuronium (intermediate acting)</p>\n<p>5. Rapacuronium (short acting)</p>\n</td>\n<td>\n<p>1. D-tubocuranine (long acting)</p>\n<p>2. Doxacurium (long acting)</p>\n<p>3. Atracurium (intermediate acting)</p>\n<p>4. Cis-atracurium (intermediate acting)</p>\n<p>5. Mivacurium (short acting)</p>\n<p>Release Histamine</p>\n<p>1. Vasodilation</p>\n<p>2. Decrease BP, Increase HR</p>\n<p>3. Flushing, bronchospasm</p>\n<ul>\n<li>Unstable cardiovascular</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Succinylcholine</strong></p>\n</td>\n<td>\n<p><strong>NDNMB</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Fasiculation +</li>\n<li>Post-op <span class=\"customMeta\" data-dictid=\"0868f47e42169277719358f65df7e6\">myalgia</span> +</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>--</li>\n<li>- --</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<ul>\n<li>Reversal by <span class=\"customMeta\" data-dictid=\"745c56551716927771931e99109e78\">neostigmine</span> (increasing the quantity of <span class=\"customMeta\" data-dictid=\"fba05f424716927771802b63f6c392\">ach</span> by inhibing <span class=\"customMeta\" data-dictid=\"fba05f424716927771802b63f6c392\">ach</span> esterase)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following nerves is popularly used in clinical anesthesia to monitor neuromuscular blockade?", "options": [{"label": "A", "text": "Ulnar Nerve", "correct": true}, {"label": "B", "text": "Median Nerve", "correct": false}, {"label": "C", "text": "Radial nerve", "correct": false}, {"label": "D", "text": "Mandibular nerve", "correct": false}], "correct_answer": "A. Ulnar Nerve", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/1MSu07HJccPCWfSII7eI1715663814.png"], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\"&gt;Ulnar&lt;/span&gt; Nerv\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the Mallampati class of this patient", "options": [{"label": "A", "text": "Class II", "correct": true}, {"label": "B", "text": "Class I", "correct": false}, {"label": "C", "text": "Class IV", "correct": false}, {"label": "D", "text": "Class III", "correct": false}], "correct_answer": "A. Class II", "question_images": ["https://image.prepladder.com/content/Tf1Ow8FqeZSFERKbGd2V1687865666.png"], "explanation_images": ["https://image.prepladder.com/content/rLldu22ABYoupW0gSM5z1691452913.png"], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Involvement</strong></p>\n</td>\n<td>\n<p><strong>Grade 0 tip of <span class=\"customMeta\" data-dictid=\"7056fd87c916927771872a0a0c6ece\">epiglottis</span> is visible</strong></p>\n</td>\n<td>\n<p><strong>Grade I</strong></p>\n</td>\n<td>\n<p><strong>Grade II</strong></p>\n</td>\n<td>\n<p><strong>Grade III</strong></p>\n</td>\n<td>\n<p><strong>Grade IV</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Hard palate</strong></p>\n</td>\n<td>\n<p> </p>\n</td>\n<td>\n<p>+</p>\n</td>\n<td>\n<p>+</p>\n</td>\n<td>\n<p>+</p>\n</td>\n<td>\n<p>+</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Soft palate</strong></p>\n</td>\n<td>\n<p> </p>\n</td>\n<td>\n<p>+</p>\n</td>\n<td>\n<p>+</p>\n</td>\n<td>\n<p>+</p>\n</td>\n<td>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Uvula</strong></p>\n</td>\n<td>\n<p> </p>\n</td>\n<td>\n<p>+</p>\n</td>\n<td>\n<p>+</p>\n</td>\n<td>\n<p>Only base of uvula</p>\n</td>\n<td>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Fauces</strong></p>\n</td>\n<td>\n<p> </p>\n</td>\n<td>\n<p>+</p>\n</td>\n<td>\n<p>+</p>\n</td>\n<td>\n<p> </p>\n</td>\n<td>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Tonsillar pillar</strong></p>\n</td>\n<td>\n<p> </p>\n</td>\n<td>\n<p>+</p>\n</td>\n<td>\n<p> </p>\n</td>\n<td>\n<p> </p>\n</td>\n<td>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Where can the devices in Murphy's eye be observed?", "options": [{"label": "A", "text": "Nasopharyngeal airway", "correct": false}, {"label": "B", "text": "Laryngoscope", "correct": false}, {"label": "C", "text": "Bronchoscope", "correct": false}, {"label": "D", "text": "Endotracheal tube", "correct": true}], "correct_answer": "D. Endotracheal tube", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/snTkEpnOqBCsFqOSLdFn1691453022.png"], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"cdccef317a1692777187a7bc217232\"&gt;Endotracheal&lt;/span&gt; tu\n<table>\n<tbody>\n<tr>\n<td colspan=\"2\">\n<p style=\"text-align:center\"><strong>Used to determine the size of tube</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Size</p>\n</td>\n<td>\n<p>Depth of insertion</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>female, 7-8 mm ID.</p>\n</td>\n<td>\n<p>20-22.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Male, 8-9 mm ID.</p>\n</td>\n<td>\n<p>21-23.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Pediatric: older than 6 years of age: ( Age/4) +4.5 mm. Younger than 6 years of age: (Age/3) +3.5 mm.</p>\n</td>\n<td>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The following cells seen in the lymph node are indicative of:", "options": [{"label": "A", "text": "Infectious mononucleosis", "correct": false}, {"label": "B", "text": "Measles", "correct": true}, {"label": "C", "text": "CMV infection", "correct": false}, {"label": "D", "text": "Influenza", "correct": false}], "correct_answer": "B. Measles", "question_images": ["https://image.prepladder.com/content/6D0E7WbsfBbm8dDkahXX1691453135.png"], "explanation_images": ["https://image.prepladder.com/content/6D0E7WbsfBbm8dDkahXX1691453135.png", "https://image.prepladder.com/content/6D0E7WbsfBbm8dDkahXX1691453135.png"], "explanation": "<p>Correct Option B - M\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which circuit is the most efficient for administering anesthesia while allowing for spontaneous breathing?", "options": [{"label": "A", "text": "Mapleson A", "correct": true}, {"label": "B", "text": "Mapleson B", "correct": false}, {"label": "C", "text": "Mapleson C", "correct": false}, {"label": "D", "text": "Mapleson D", "correct": false}], "correct_answer": "A. Mapleson A", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ocTBW9F5H3WRyxhzp5aY1687773150.png"], "explanation": "<p>Correct Option A: Mapleson A\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most common site for an extragonadal germ cell tumor?", "options": [{"label": "A", "text": "Pineal gland", "correct": false}, {"label": "B", "text": "Retroperitoneum", "correct": false}, {"label": "C", "text": "Sacrococcygeal region", "correct": false}, {"label": "D", "text": "Mediastinum", "correct": true}], "correct_answer": "D. Mediastinum", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The best type of anesthesia for pre eclampsia is:", "options": [{"label": "A", "text": "Spinal anesthesia", "correct": false}, {"label": "B", "text": "Epidural anesthesia", "correct": true}, {"label": "C", "text": "General anesthesia", "correct": false}, {"label": "D", "text": "Caudal block", "correct": false}], "correct_answer": "B. Epidural anesthesia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"6de01005f61692777187a3003970c7\"&gt;Epidural&lt;/span&gt; anesth\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "If epinephrine fails to be effective, what other medication would you consider using for cardiac arrest?", "options": [{"label": "A", "text": "Vasopressin", "correct": false}, {"label": "B", "text": "Atropine", "correct": false}, {"label": "C", "text": "Amiodarone", "correct": true}, {"label": "D", "text": "Adenosine", "correct": false}], "correct_answer": "C. Amiodarone", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is responsible for the negative charge in fibrinopeptide A?", "options": [{"label": "A", "text": "Glutamate and valine", "correct": false}, {"label": "B", "text": "Histidine and lysine", "correct": false}, {"label": "C", "text": "Aspartate and glutamate", "correct": true}, {"label": "D", "text": "Serine and threonine", "correct": false}], "correct_answer": "C. Aspartate and glutamate", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Aspartate and glu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is true about DNA polymerase I?", "options": [{"label": "A", "text": "It is involved in the creation of Okazaki fragments", "correct": false}, {"label": "B", "text": "It is found in prokaryotes", "correct": true}, {"label": "C", "text": "It synthesizes RNA primers", "correct": false}, {"label": "D", "text": "It is the primary enzyme of DNA synthesis", "correct": false}], "correct_answer": "B. It is found in prokaryotes", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - It is found in prok\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Due to the lack of ________________, nude mice do not exhibit resistance to xenografts.", "options": [{"label": "A", "text": "B cell", "correct": false}, {"label": "B", "text": "T cell", "correct": true}, {"label": "C", "text": "Both B and T cell", "correct": false}, {"label": "D", "text": "NK cell", "correct": false}], "correct_answer": "B. T cell", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - T C\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What does Burkholderia cepacia exhibit resistance to among the options provided?", "options": [{"label": "A", "text": "Ceftazidime", "correct": false}, {"label": "B", "text": "Trimethoprim – sulfamethoxazole", "correct": false}, {"label": "C", "text": "Temocillin", "correct": false}, {"label": "D", "text": "Cefotetan", "correct": true}], "correct_answer": "D. Cefotetan", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - C\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the causative agent for scombroid food poisoning among the following organisms?", "options": [{"label": "A", "text": "Salmonella", "correct": false}, {"label": "B", "text": "Staphylococcus", "correct": false}, {"label": "C", "text": "Pseudomonas aeruginosa", "correct": true}, {"label": "D", "text": "Peptostreptococcus", "correct": false}], "correct_answer": "C. Pseudomonas aeruginosa", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"dea08f9dd81692777196a5f62e6862\"&gt;Pseudomonas&lt;/span&gt; Aerug\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During the period between 1 to 4 months following renal transplantation, which pathogen is most commonly responsible for infecting renal transplant recipients?", "options": [{"label": "A", "text": "Cytomegalovirus", "correct": true}, {"label": "B", "text": "JC virus", "correct": false}, {"label": "C", "text": "BK virus", "correct": false}, {"label": "D", "text": "Epstein-Barr virus", "correct": false}], "correct_answer": "A. Cytomegalovirus", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Cytomegaloviru\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "For which condition is the Sabin-Feldman dye test utilized in diagnosing?", "options": [{"label": "A", "text": "Paragonimiasis", "correct": false}, {"label": "B", "text": "Hydatid cyst", "correct": false}, {"label": "C", "text": "Toxoplasmosis", "correct": true}, {"label": "D", "text": "Cryptococcus", "correct": false}], "correct_answer": "C. Toxoplasmosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - T\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the term used to refer to the antigen known as Australia antigen among the options provided?", "options": [{"label": "A", "text": "HBsAg", "correct": true}, {"label": "B", "text": "HBeAg", "correct": false}, {"label": "C", "text": "HBcAg", "correct": false}, {"label": "D", "text": "HBX", "correct": false}], "correct_answer": "A. HBsAg", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/poJsxzNEE9foXV69PfSM1712745164.png"], "explanation": "<p>Correct Option A - HBsAg:</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Structural proteins of HBV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>P – DNA Polymerase</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Largest</li>\n<li>Reverse transcriptase</li>\n<li>RNAse</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>C – Core gene</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Has a core area and a pre-core area</li>\n<li>Core area coats for C antigen</li>\n<li>Pre-core area codes for E antigen</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>S – Surface <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">Antigen</span> (Australia Antigen)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>These have different sizes (Small, medium and large)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>X – HBX responsible for carcinogenesis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Liver (Hepatocellular carcinoma)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which statement accurately describes an allosteric modifier?", "options": [{"label": "A", "text": "Desaturates the enzyme", "correct": false}, {"label": "B", "text": "This causes the enzyme to worker faster only", "correct": false}, {"label": "C", "text": "Binds to the catalytic site", "correct": false}, {"label": "D", "text": "Participates in feedback regulation", "correct": true}], "correct_answer": "D. Participates in feedback regulation", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Participates in feedback regu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Bacterial transduction occurs by", "options": [{"label": "A", "text": "Plasmids", "correct": false}, {"label": "B", "text": "Sex pilli", "correct": false}, {"label": "C", "text": "Bacteriophage", "correct": true}, {"label": "D", "text": "Uptake of genetic material by other bacteria", "correct": false}], "correct_answer": "C. Bacteriophage", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Bacteriophage:</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Types of Bacteriophages</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Virulent phage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Temperate phage</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Dangerous</li>\n<li>Follow only <span class=\"customMeta\" data-dictid=\"d54da38aaa1692777191560f60c0f9\">lytic</span> cycle</li>\n<li>Ex: T<sub>1</sub> and T<sub>2</sub> <span class=\"customMeta\" data-dictid=\"d40be13a521692777194d54f866a62\">phage</span> of E.coli</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Less dangerous</li>\n<li>Follow both <span class=\"customMeta\" data-dictid=\"d54da38aaa1692777191560f60c0f9\">lytic</span> and <span class=\"customMeta\" data-dictid=\"38000b363e1692777191e63fbc7c30\">lysogenic</span> cycle</li>\n<li>Ex: <span class=\"customMeta\" data-dictid=\"480a28f2ba1692777191df6f60792d\">Lambda</span> <span class=\"customMeta\" data-dictid=\"d40be13a521692777194d54f866a62\">phage</span> of E. coli</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Types of Bacteriophages</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Virulent phage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Temperate phage</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Dangerous</li>\n<li>Follow only <span class=\"customMeta\" data-dictid=\"d54da38aaa1692777191560f60c0f9\">lytic</span> cycle</li>\n<li>Ex: T<sub>1</sub> and T<sub>2</sub> <span class=\"customMeta\" data-dictid=\"d40be13a521692777194d54f866a62\">phage</span> of E.coli</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Less dangerous</li>\n<li>Follow both <span class=\"customMeta\" data-dictid=\"d54da38aaa1692777191560f60c0f9\">lytic</span> and <span class=\"customMeta\" data-dictid=\"38000b363e1692777191e63fbc7c30\">lysogenic</span> cycle</li>\n<li>Ex: <span class=\"customMeta\" data-dictid=\"480a28f2ba1692777191df6f60792d\">Lambda</span> <span class=\"customMeta\" data-dictid=\"d40be13a521692777194d54f866a62\">phage</span> of E. coli</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most frequently occurring end-product of the pathway for fatty acid synthesis among the options provided?", "options": [{"label": "A", "text": "Arachidonic acid", "correct": false}, {"label": "B", "text": "Oleic acid", "correct": false}, {"label": "C", "text": "Palmitic acid", "correct": true}, {"label": "D", "text": "Acetyl CoA", "correct": false}], "correct_answer": "C. Palmitic acid", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - P\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In patients with diabetic ketoacidosis, which type of fungus is frequently linked to orbital cellulitis?", "options": [{"label": "A", "text": "Candida", "correct": false}, {"label": "B", "text": "Rhizopus", "correct": true}, {"label": "C", "text": "Aspergillus", "correct": false}, {"label": "D", "text": "Trichophyton", "correct": false}], "correct_answer": "B. Rhizopus", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Rhizopu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In which of the following cases is the adult form of echinococcus observed?", "options": [{"label": "A", "text": "Dog", "correct": true}, {"label": "B", "text": "Cat", "correct": false}, {"label": "C", "text": "Swine", "correct": false}, {"label": "D", "text": "Sheep", "correct": false}], "correct_answer": "A. Dog", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Dog\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following organisms can thrive in an acidic pH?", "options": [{"label": "A", "text": "Vibrio", "correct": false}, {"label": "B", "text": "Lactobacilli", "correct": true}, {"label": "C", "text": "Salmonella", "correct": false}, {"label": "D", "text": "Shigella", "correct": false}], "correct_answer": "B. Lactobacilli", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - L\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the vector for the condition diagnosed by the image shown below?", "options": [{"label": "A", "text": "Anopheles mosquito", "correct": false}, {"label": "B", "text": "Ixodes Tick", "correct": false}, {"label": "C", "text": "Sandfly", "correct": true}, {"label": "D", "text": "Tsetse fly", "correct": false}], "correct_answer": "C. Sandfly", "question_images": ["https://image.prepladder.com/content/qLpOdZNde9fA9qksubXM1714376613.png"], "explanation_images": [], "explanation": "<p>Correct Option C - S\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "TB test done only on whole blood sample is ______________.", "options": [{"label": "A", "text": "TrueNat TB", "correct": false}, {"label": "B", "text": "GeneXpert", "correct": false}, {"label": "C", "text": "Interferon gamma release assay", "correct": true}, {"label": "D", "text": "MGIT system", "correct": false}], "correct_answer": "C. Interferon gamma release assay", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Interferon-g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which statement regarding vitamin K is accurate?", "options": [{"label": "A", "text": "A deficiency of vitamin K leads to hypercoagulability", "correct": false}, {"label": "B", "text": "It is a water-soluble vitamin", "correct": false}, {"label": "C", "text": "Prolonged use of antibiotics leads to vitamin K deficiency", "correct": true}, {"label": "D", "text": "Menaquinone is the dietary source of vitamin K found in green vegetables.", "correct": false}], "correct_answer": "C. Prolonged use of antibiotics leads to vitamin K deficiency", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C: Prolonged use of antibiotics leads to &lt;span class=\"customMeta\" data-dictid=\"71c2092f15169277720243eb1590b0\"&gt;vitamin K&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What causes the formation of multiple abscesses with discharging sinuses that show the presence of sulphur granules in the pus?", "options": [{"label": "A", "text": "Actinomyces israelii", "correct": true}, {"label": "B", "text": "Nocardia", "correct": false}, {"label": "C", "text": "Salmonella", "correct": false}, {"label": "D", "text": "Tularemia", "correct": false}], "correct_answer": "A. Actinomyces israelii", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"745491e27716927771800bea2f55dd\"&gt;Actinomyces&lt;/span&gt; I\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Vanillyl mandelic acid excreted in the urine in which of the following conditions?", "options": [{"label": "A", "text": "Pheochromocytoma", "correct": true}, {"label": "B", "text": "Alkaptonuria", "correct": false}, {"label": "C", "text": "Carcinoid syndrome", "correct": false}, {"label": "D", "text": "Diabetic ketoacidosis", "correct": false}], "correct_answer": "A. Pheochromocytoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Pheoch\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the organism?", "options": [{"label": "A", "text": "Strongyloides stercolaris", "correct": false}, {"label": "B", "text": "Toxocara canis", "correct": false}, {"label": "C", "text": "Ancylostoma braziliense", "correct": true}, {"label": "D", "text": "Necator americanus", "correct": false}], "correct_answer": "C. Ancylostoma braziliense", "question_images": ["https://image.prepladder.com/content/RuqOzGuTlKh6vHAlgsDl1700116802.png"], "explanation_images": ["https://image.prepladder.com/content/KPA71Dg1EZuCdHsP62221700116888.png", "https://image.prepladder.com/content/0qPrnnRjRiVJVWHfWc3q1700116917.png", "https://image.prepladder.com/content/nT0zk48ozTsnZAIdY4l11700116954.png"], "explanation": "<p>Correct Option C: A\n<table>\n<thead>\n<tr>\n<th><strong>Aspect</strong></th>\n<th><strong>Description</strong></th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td><strong>Common Name</strong></td>\n<td>Dog <span class=\"customMeta\" data-dictid=\"2db7faaac316927771894a9f7f00bc\">hookworm</span> (also known as the Brazilian dog hookworm)</td>\n</tr>\n<tr>\n<td><strong>Scientific Name</strong></td>\n<td>Ancylostoma braziliense</td>\n</tr>\n<tr>\n<td><strong>Phylum</strong></td>\n<td>Nematoda (roundworms)</td>\n</tr>\n<tr>\n<td><strong>Habitat</strong></td>\n<td>Small <span class=\"customMeta\" data-dictid=\"7840cca3ed16927771901d2f6cb32b\">intestine</span> of dogs and other canids</td>\n</tr>\n<tr>\n<td><strong>Geographic Distribution</strong></td>\n<td>Found in tropical and subtropical regions, particularly in the Americas</td>\n</tr>\n<tr>\n<td><strong>Lifecycle</strong></td>\n<td>- Direct life cycle, involving the passage of eggs in the <span class=\"customMeta\" data-dictid=\"7f789a76331692777202a90df3adb4\">feces</span> of infected animals. - <span class=\"customMeta\" data-dictid=\"c2907c9f0016927771914eedf733dd\">Larvae</span> hatch from eggs and develop into <span class=\"customMeta\" data-dictid=\"802328b229169277719000601489eb\">infective</span> <span class=\"customMeta\" data-dictid=\"c2907c9f0016927771914eedf733dd\">larvae</span> in the environment. - Infection occurs through skin <span class=\"customMeta\" data-dictid=\"31dd0b58bb1692777195e6016ecd51\">penetration</span> by <span class=\"customMeta\" data-dictid=\"802328b229169277719000601489eb\">infective</span> <span class=\"customMeta\" data-dictid=\"c2907c9f0016927771914eedf733dd\">larvae</span> or <span class=\"customMeta\" data-dictid=\"eba893313f16927771906290ce7e79\">ingestion</span> of larvae-contaminated material.- Adults in the small <span class=\"customMeta\" data-dictid=\"7840cca3ed16927771901d2f6cb32b\">intestine</span> produce eggs, restarting the cycle.</td>\n</tr>\n<tr>\n<td><strong>Morphology (Adult)</strong></td>\n<td>- Small, slender nematode. - Males: 8-11 mm in length with a curved <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> end. - Females: 10-13 mm in length with a straighter <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> end.</td>\n</tr>\n<tr>\n<td><strong>Morphology (Eggs)</strong></td>\n<td>- Small, oval-shaped eggs with thin shells. - Eggs are passed in the <span class=\"customMeta\" data-dictid=\"7f789a76331692777202a90df3adb4\">feces</span> of infected animals.</td>\n</tr>\n<tr>\n<td><strong>Clinical Significance</strong></td>\n<td>- <span class=\"customMeta\" data-dictid=\"3e321b95591692777181093f6ad844\">Ancylostoma</span> braziliense can cause a condition known as <span class=\"customMeta\" data-dictid=\"94f1c8df1f1692777185bd6a7c3fff\">cutaneous</span> <span class=\"customMeta\" data-dictid=\"48bab7934a16927771917c5a2bf7e2\">larva</span> migrans (CLM) in humans, characterized by itchy, <span class=\"customMeta\" data-dictid=\"7ab35d64bd16927771981c8135b442\">serpiginous</span> skin lesions. - In dogs, the infection can lead to <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> signs such as <span class=\"customMeta\" data-dictid=\"aaabe672c51692777186a829ebdc0c\">diarrhea</span> and anemia.</td>\n</tr>\n<tr>\n<td><strong>Zoonotic Potential</strong></td>\n<td>- <span class=\"customMeta\" data-dictid=\"3e321b95591692777181093f6ad844\">Ancylostoma</span> braziliense is zoonotic, and humans can become <span class=\"customMeta\" data-dictid=\"fb7ff97e071692777180252299cf10\">accidental</span> hosts, experiencing <span class=\"customMeta\" data-dictid=\"94f1c8df1f1692777185bd6a7c3fff\">cutaneous</span> <span class=\"customMeta\" data-dictid=\"48bab7934a16927771917c5a2bf7e2\">larva</span> migrans (creeping eruption) when <span class=\"customMeta\" data-dictid=\"c2907c9f0016927771914eedf733dd\">larvae</span> penetrate the skin.</td>\n</tr>\n<tr>\n<td><strong>Prevention and Control</strong></td>\n<td>- Regular <span class=\"customMeta\" data-dictid=\"1defe825941692777186e6378c4c76\">deworming</span> of dogs to reduce the shedding of <span class=\"customMeta\" data-dictid=\"802328b229169277719000601489eb\">infective</span> larvae. - Proper disposal of dog <span class=\"customMeta\" data-dictid=\"7f789a76331692777202a90df3adb4\">feces</span> to minimize environmental contamination.</td>\n</tr>\n<tr>\n<td><strong>Diagnosis</strong></td>\n<td>- Identification of characteristic eggs in fecal samples through <span class=\"customMeta\" data-dictid=\"79067cb33316927771926965c3c0b5\">microscopic</span> examination. - Clinical signs and history of exposure to contaminated environments.</td>\n</tr>\n<tr>\n<td><strong>Treatment</strong></td>\n<td>- <span class=\"customMeta\" data-dictid=\"3cacaaae1516927771816a405ff320\">Anthelmintic</span> medications, such as benzimidazoles or <span class=\"customMeta\" data-dictid=\"781318b0df16927771912dd5c93900\">macrocyclic</span> lactones, are effective in treating <span class=\"customMeta\" data-dictid=\"3e321b95591692777181093f6ad844\">Ancylostoma</span> braziliense infections in dogs. - <span class=\"customMeta\" data-dictid=\"94f1c8df1f1692777185bd6a7c3fff\">Cutaneous</span> <span class=\"customMeta\" data-dictid=\"48bab7934a16927771917c5a2bf7e2\">larva</span> migrans in humans may be self-limiting, but medications may be prescribed for <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> relief.</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Serotonin is also known as?", "options": [{"label": "A", "text": "5 hydroxy tryptamine", "correct": true}, {"label": "B", "text": "5 hydroxytryptophan", "correct": false}, {"label": "C", "text": "5 carboxy tryptamine", "correct": false}, {"label": "D", "text": "5 carboxy tryptophan", "correct": false}], "correct_answer": "A. 5 hydroxy tryptamine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - 5 h\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is absent in the urine of a patient who presents with recurrent kidney stones? Below in the microscopic eamination of the patient’s urine sample.", "options": [{"label": "A", "text": "Arginine", "correct": false}, {"label": "B", "text": "Lysine", "correct": false}, {"label": "C", "text": "Cystine", "correct": false}, {"label": "D", "text": "Cysteine", "correct": true}], "correct_answer": "D. Cysteine", "question_images": ["https://image.prepladder.com/content/54wSvhOtCl6XYmRYqY971715670830.png"], "explanation_images": [], "explanation": "<p>Correct Option D - C\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What type of hypersensitivity reaction is implicated in the hyperacute rejection of kidney transplants?", "options": [{"label": "A", "text": "Type IV", "correct": false}, {"label": "B", "text": "Type III", "correct": false}, {"label": "C", "text": "Type II", "correct": true}, {"label": "D", "text": "Type I", "correct": false}], "correct_answer": "C. Type II", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Type II\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In which condition is there an excessive excretion of 5-hydroxy indole acetic acid in the urine?", "options": [{"label": "A", "text": "Alkaptonuria", "correct": false}, {"label": "B", "text": "Albinism", "correct": false}, {"label": "C", "text": "Carcinoid syndrome", "correct": true}, {"label": "D", "text": "Phenylketonuria", "correct": false}], "correct_answer": "C. Carcinoid syndrome", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Carcinoid S\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the organisms listed below are capable of producing urease?", "options": [{"label": "A", "text": "Helicobacter pylori", "correct": true}, {"label": "B", "text": "Salmonella", "correct": false}, {"label": "C", "text": "Escherichia coli", "correct": false}, {"label": "D", "text": "Shigella", "correct": false}], "correct_answer": "A. Helicobacter pylori", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"313a9372811692777188be2ca0dedc\"&gt;Helicobacter&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following should be avoided by a patient with fish odor syndrome?", "options": [{"label": "A", "text": "Biotin", "correct": false}, {"label": "B", "text": "Choline", "correct": true}, {"label": "C", "text": "Niacin", "correct": false}, {"label": "D", "text": "Pantothenic acid", "correct": false}], "correct_answer": "B. Choline", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Ch\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which antibiotics are Mycoplasma naturally resistant to?", "options": [{"label": "A", "text": "Beta lactam antibiotics", "correct": true}, {"label": "B", "text": "Macrolides", "correct": false}, {"label": "C", "text": "Tetracycline", "correct": false}, {"label": "D", "text": "Fluoroquinolones", "correct": false}], "correct_answer": "A. Beta lactam antibiotics", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Beta-lactam A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What do chaperones assist in?", "options": [{"label": "A", "text": "Ubiquitination of proteins", "correct": false}, {"label": "B", "text": "Protein modification", "correct": false}, {"label": "C", "text": "Protein folding", "correct": true}, {"label": "D", "text": "Protein cleavage", "correct": false}], "correct_answer": "C. Protein folding", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C: Protein folding\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Pasteurization is done at .....................", "options": [{"label": "A", "text": "73 degree Celsius for 20 minutes", "correct": false}, {"label": "B", "text": "63 degree Celsius for 30 minutes", "correct": true}, {"label": "C", "text": "72 degree Celsius for 30 seconds", "correct": false}, {"label": "D", "text": "63 degree Celsius for 30 seconds", "correct": false}], "correct_answer": "B. 63 degree Celsius for 30 minutes", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - 63 degrees Celsius for 30 minu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Defective fumarylacetoacetate hydrolase enzyme is associated with___", "options": [{"label": "A", "text": "Type 1 Tyrosinemia", "correct": true}, {"label": "B", "text": "Type 2 Tyrosinemia", "correct": false}, {"label": "C", "text": "Type 3 Tyrosinemia", "correct": false}, {"label": "D", "text": "Type 4 Tyrosinemia", "correct": false}], "correct_answer": "A. Type 1 Tyrosinemia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Type 1 T\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A newborn baby refuses breast milk since the 2 nd day of birth but accepts glucose water. He develops vomiting and severe jaundice by the 5 th day. Benedict’s test was positive for urine, and blood glucose was low. The most likely cause is due to the deficiency of:", "options": [{"label": "A", "text": "Aldose reductase", "correct": false}, {"label": "B", "text": "Galactokinase", "correct": false}, {"label": "C", "text": "Galactose-1-phosphate uridyl transferase", "correct": true}, {"label": "D", "text": "UDP galactose-4- epimerase", "correct": false}], "correct_answer": "C. Galactose-1-phosphate uridyl transferase", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Galactose-1-phosphate u\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What would be the recommended treatment for simple myopic astigmatism among the following options?", "options": [{"label": "A", "text": "+1.00 DS", "correct": false}, {"label": "B", "text": "-1.00 DC × 180 degree", "correct": true}, {"label": "C", "text": "-1.00 DS", "correct": false}, {"label": "D", "text": "-1.00 DS – 1.00 × 180 degree", "correct": false}], "correct_answer": "B. -1.00 DC × 180 degree", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/BqGTZvHzdCbodJCzOOLl1695187945.png"], "explanation": "<p>Correct Option B: -1.00 DC × 180 deg\n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td style=\"text-align:center\"><strong>Axis-I</strong></td>\n<td style=\"text-align:center\"><strong>Axis-II</strong></td>\n<td style=\"text-align:center\"><strong>Type of astigmatism </strong></td>\n</tr>\n<tr>\n<td style=\"text-align:center\">Normal</td>\n<td style=\"text-align:center\">+</td>\n<td style=\"text-align:center\">Simple hypermetropic </td>\n</tr>\n<tr>\n<td style=\"text-align:center\">Normal </td>\n<td style=\"text-align:center\">-</td>\n<td style=\"text-align:center\">Simple myopic </td>\n</tr>\n<tr>\n<td style=\"text-align:center\">+</td>\n<td style=\"text-align:center\">+</td>\n<td style=\"text-align:center\">Compound hypermetropic </td>\n</tr>\n<tr>\n<td style=\"text-align:center\">-</td>\n<td style=\"text-align:center\">-</td>\n<td style=\"text-align:center\">Compound myopic </td>\n</tr>\n<tr>\n<td style=\"text-align:center\">+</td>\n<td style=\"text-align:center\">-</td>\n<td style=\"text-align:center\">Mixed astigmatism </td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old woman with hypertriglyceridemia is considered for niacin therapy. She is a known diabetic managed adequately with sugars well under control. Why should niacin be used cautiously in this patient?", "options": [{"label": "A", "text": "It can cause hyperglycemia.", "correct": true}, {"label": "B", "text": "It can cause scleroderma, which makes injecting insulin difficult", "correct": false}, {"label": "C", "text": "It can increase the metabolism of oral hypoglycemic drugs", "correct": false}, {"label": "D", "text": "It can cause hypoglycemia", "correct": false}], "correct_answer": "A. It can cause hyperglycemia.", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - It can cause hyperg\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which microorganism is responsible for angular conjunctivitis?", "options": [{"label": "A", "text": "Moraxella lacunata", "correct": true}, {"label": "B", "text": "Haemophilus influenzae", "correct": false}, {"label": "C", "text": "Adenovirus type 32", "correct": false}, {"label": "D", "text": "Coxsackie B virus", "correct": false}], "correct_answer": "A. Moraxella lacunata", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/GimnTPcIWzJILhFHNq1l1695189058.png"], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"e641ced0f016927771926ee6999bbb\"&gt;Moraxella&lt;/span&gt; lacu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following mechanisms can modify gene expression through methylation and acetylation without altering the gene sequence?", "options": [{"label": "A", "text": "Mutation", "correct": false}, {"label": "B", "text": "Epigenetics", "correct": true}, {"label": "C", "text": "Translocation", "correct": false}, {"label": "D", "text": "Inversion", "correct": false}], "correct_answer": "B. Epigenetics", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Epig\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In developed countries, what is the primary etiology responsible for ophthalmia neonatorum ?", "options": [{"label": "A", "text": "Chlamydia", "correct": true}, {"label": "B", "text": "Gonorrhoea", "correct": false}, {"label": "C", "text": "Chemical conjunctivitis", "correct": false}, {"label": "D", "text": "Staphylococcus aureus", "correct": false}], "correct_answer": "A. Chlamydia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Ch\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The flipped LDH ratio implies____", "options": [{"label": "A", "text": "LDH 1 &amp;gt; LDH 2", "correct": true}, {"label": "B", "text": "LDH 2 &amp;gt; LDH 1", "correct": false}, {"label": "C", "text": "LDH 2 &amp;gt; LDH 3", "correct": false}, {"label": "D", "text": "LDH 3 &amp;gt; LDH 2", "correct": false}], "correct_answer": "A. LDH 1 &gt; LDH 2", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - LDH 1 &amp;gt; &lt;span class=\"customMeta\" data-dictid=\"511c533d8b1692777191aa64479963\"&gt;LDH&lt;/span&gt; 2\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>LDH Isozyme</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Composition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>LDH-1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>H4</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Heart</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>LDH-2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>H3M1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>RBCs, heart</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>LDH-3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>H2M2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lungs, brain , platelet, <span class=\"customMeta\" data-dictid=\"4fb6bd90f016927771918d4a2993ed\">lymphatic</span> tissue</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>LDH-4</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>H1M3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Liver, Skeletal muscle</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>LDH-5</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>M4</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Liver, Skeletal muscle,</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the underlying factor responsible for the development of acute hemorrhagic conjunctivitis ?", "options": [{"label": "A", "text": "Enterovirus 68", "correct": false}, {"label": "B", "text": "Enterovirus 72", "correct": false}, {"label": "C", "text": "Enterovirus 70", "correct": true}, {"label": "D", "text": "Enterovirus 71", "correct": false}], "correct_answer": "C. Enterovirus 70", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"808ea4002d16927771876fa4cb31f7\"&gt;Enterovirus&lt;/span&gt; 7\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In which of the following conditions is 100-day glaucoma observed?", "options": [{"label": "A", "text": "Central retinal vein occlusion", "correct": true}, {"label": "B", "text": "Eale’s disease", "correct": false}, {"label": "C", "text": "Central retinal artery occlusion", "correct": false}, {"label": "D", "text": "Steroid – induced glaucoma", "correct": false}], "correct_answer": "A. Central retinal vein occlusion", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Central &lt;span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\"&gt;retinal&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\"&gt;vein&lt;/span&gt; occlu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Yoke muscle of the right lateral rectus in dextroversion is _________________.", "options": [{"label": "A", "text": "Left superior oblique", "correct": false}, {"label": "B", "text": "Left medial rectus", "correct": true}, {"label": "C", "text": "Left inferior rectus", "correct": false}, {"label": "D", "text": "Right superior rectus", "correct": false}], "correct_answer": "B. Left medial rectus", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Yo2ZYtlWj9ez8Wo7GHEH1715256210.png"], "explanation": "<p>Correct Option B - Left &lt;span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\"&gt;medial&lt;/span&gt; rectu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient, 36 hours after cataract surgery, presents with complaints of pain and visual disturbance . His eye is as shown below. What is the management of this condition?", "options": [{"label": "A", "text": "Intravenous steroids", "correct": false}, {"label": "B", "text": "Intravenous antibiotics", "correct": false}, {"label": "C", "text": "Bandage and padding of the eye", "correct": false}, {"label": "D", "text": "Intravitreal antibiotics", "correct": true}], "correct_answer": "D. Intravitreal antibiotics", "question_images": ["https://image.prepladder.com/content/f67iPJULeuYVjgjBGkFh1691453467.png"], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"67c9bce29d169277719036007848c0\"&gt;Intravitreal&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a case of long-standing, uncontrolled diabetes, what is the most common characteristic of third nerve palsy?", "options": [{"label": "A", "text": "Limited abduction", "correct": false}, {"label": "B", "text": "Pseudoptosis", "correct": false}, {"label": "C", "text": "Ptosis", "correct": true}, {"label": "D", "text": "Pupillary dysfunction", "correct": false}], "correct_answer": "C. Ptosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - P\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most common site of an orbital blowout fracture?", "options": [{"label": "A", "text": "Medial wall", "correct": false}, {"label": "B", "text": "Lateral wall", "correct": false}, {"label": "C", "text": "Roof", "correct": false}, {"label": "D", "text": "Floor", "correct": true}], "correct_answer": "D. Floor", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - F\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented with tabes dorsalis. What will be observed when his pupils are exposed to light?", "options": [{"label": "A", "text": "Pupils react but do not accommodate", "correct": false}, {"label": "B", "text": "Pupils accommodate but do not react", "correct": true}, {"label": "C", "text": "Pupils neither react not accommodate", "correct": false}, {"label": "D", "text": "Pupils react and accommodate", "correct": false}], "correct_answer": "B. Pupils accommodate but do not react", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Pupils accommodate bu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Roth spots are seen in ____________.", "options": [{"label": "A", "text": "Acute leukemia", "correct": true}, {"label": "B", "text": "Uveitis", "correct": false}, {"label": "C", "text": "Optic neuritis", "correct": false}, {"label": "D", "text": "Vogt-Koyanagi-Harada syndrome", "correct": false}], "correct_answer": "A. Acute leukemia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/44CT6rl9WtU9W2zzkceu1715162259.png", "https://image.prepladder.com/content/Hl9Lpe1UAih9Sa3zoOxJ1715158312.png"], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\"&gt;Acute&lt;/span&gt; leuk\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What should be the power of prescription glasses for a 50-year-old man who is presbyopic?", "options": [{"label": "A", "text": "+1D", "correct": false}, {"label": "B", "text": "+2D", "correct": true}, {"label": "C", "text": "+3D", "correct": false}, {"label": "D", "text": "+4D", "correct": false}], "correct_answer": "B. +2D", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B: +2D\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "De Quervain's tenosynovitis involves the tendons of which muscles ?", "options": [{"label": "A", "text": "Extensor pollicis longus and abductor pollicis longus", "correct": false}, {"label": "B", "text": "Extensor pollicis longus and abductor pollicis brevis", "correct": false}, {"label": "C", "text": "Extensor pollicis brevis and abductor pollicis brevis", "correct": false}, {"label": "D", "text": "Extensor pollicis brevis and abductor pollicis longus", "correct": true}], "correct_answer": "D. Extensor pollicis brevis and abductor pollicis longus", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/gxgwPZ6skvVQ8FsWhvZK1700157136.png"], "explanation": "<p>Correct Option D - Extensor pollicis brevis and &lt;span class=\"customMeta\" data-dictid=\"1a19c0413216927771801f371db10e\"&gt;abductor&lt;/span&gt; pollicis longu\n<table>\n<tbody>\n<tr>\n<td colspan=\"2\">\n<p style=\"text-align:center\"><strong>De Quervain's Disease (De Quervain's Tenosynovitis)</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Pathophysiology</strong></p>\n</td>\n<td>\n<p>Inflammation and <span class=\"customMeta\" data-dictid=\"3a74ed0fcf16927771901a79847565\">irritation</span> of the tendons and their surrounding sheath</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Common Causes</strong></p>\n</td>\n<td>\n<p>Repetitive hand and wrist motions, overuse injuries</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Symptoms</strong></p>\n</td>\n<td>\n<ul>\n<li>Pain and <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> at the base of the thumb</li>\n<li>Pain worsens with thumb and wrist movement</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Diagnosis</strong></p>\n</td>\n<td>\n<p>Clinical evaluation, physical examination, Finkelstein's test</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Treatment</strong></p>\n</td>\n<td>\n<ul>\n<li>Splinting or immobilizing the thumb and wrist</li>\n<li>Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief</li>\n<li>In severe cases, <span class=\"customMeta\" data-dictid=\"a3e96d80e9169277718551158bbcd4\">corticosteroid</span> injections or <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> intervention</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "As the intern on duty, your responsibility includes attending to patients involved in a road traffic accident. Identify the patient from the options below for whom you would promptly contact the orthopaedic resident on call.", "options": [{"label": "A", "text": "Patient with recurrent shoulder dislocation", "correct": false}, {"label": "B", "text": "Patient with a fractured arm with capillary refill time of less than 3 seconds in his fingers", "correct": false}, {"label": "C", "text": "Patient with a fractured arm with intact skin and minimal swelling.", "correct": false}, {"label": "D", "text": "Patient with a fractured arm with capillary refill time of 5 seconds in his fingers", "correct": true}], "correct_answer": "D. Patient with a fractured arm with capillary refill time of 5 seconds in his fingers", "question_images": [], "explanation_images": [], "explanation": "<table>\n<thead>\n<tr>\n<th><strong>Parameter</strong></th>\n<th><strong>Critical Concern</strong></th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>Capillary refill time</td>\n<td>&gt; 2 seconds = <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> compromise</td>\n</tr>\n<tr>\n<td>Limb color and temperature</td>\n<td>Pallor/coldness = poor perfusion</td>\n</tr>\n<tr>\n<td>Pulse examination</td>\n<td>Absent/diminished <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> pulses = arterial injury</td>\n</tr>\n<tr>\n<td>Skin status</td>\n<td>Open wounds = open <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> → risk of infection</td>\n</tr>\n<tr>\n<td>Pain disproportionate to injury</td>\n<td>Suspect <strong>compartment syndrome</strong></td>\n</tr>\n<tr>\n<td>Neurological status</td>\n<td>Paresthesia, motor weakness = possible nerve injury</td>\n</tr>\n<tr>\n<td>Swelling or <span class=\"customMeta\" data-dictid=\"12f7e36ffd16927772000cb2186249\">tense</span> compartments</td>\n<td>Consider <strong>fasciotomy</strong> if <span class=\"customMeta\" data-dictid=\"ce3edddb5116927771844c030f3c1e\">compartment</span> pressure is high</td>\n</tr>\n</tbody>\n</table>\n<table>\n<thead>\n<tr>\n<th><strong>Category</strong></th>\n<th><strong>Examples</strong></th>\n<th><strong>Urgency</strong></th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td><strong>Open fractures</strong></td>\n<td>Bone exposed or wound &gt;1 cm over <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> site</td>\n<td>Emergency <span class=\"customMeta\" data-dictid=\"66beddba7f169277719425c6d55e69\">ortho</span> consult</td>\n</tr>\n<tr>\n<td><strong>Vascular compromise</strong></td>\n<td>Absent pulses, CRT &gt;2 sec, cold limb</td>\n<td>Emergency <span class=\"customMeta\" data-dictid=\"66beddba7f169277719425c6d55e69\">ortho</span> + vascular</td>\n</tr>\n<tr>\n<td><strong>Compartment syndrome</strong></td>\n<td>Pain out of proportion, paresthesia, pallor, pulselessness, paralysis</td>\n<td>Fasciotomy indicated</td>\n</tr>\n<tr>\n<td><strong>Joint dislocations</strong></td>\n<td>Shoulder, knee, hip dislocations</td>\n<td>Urgent (but not always emergency)</td>\n</tr>\n<tr>\n<td><strong>Spinal trauma</strong></td>\n<td>Neurological deficits, high-impact injury</td>\n<td>Immobilize + MRI/CT</td>\n</tr>\n<tr>\n<td><strong>Pelvic fractures</strong></td>\n<td>Risk of hemorrhagic shock</td>\n<td>Emergency trauma care</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the condition represented in the image below:", "options": [{"label": "A", "text": "Emphysema", "correct": false}, {"label": "B", "text": "Miliary tuberculosis", "correct": true}, {"label": "C", "text": "Sarcoidosis", "correct": false}, {"label": "D", "text": "Asbestosis", "correct": false}], "correct_answer": "B. Miliary tuberculosis", "question_images": ["https://image.prepladder.com/content/LBhFIaWdqreCPh0oN6VF1713769072.png"], "explanation_images": ["https://image.prepladder.com/content/I0asDaxyEmPDtLU6SqNq1691498581.png"], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"de0ef5a95116927771922f41d2b8b5\"&gt;Miliary&lt;/span&gt; tubercu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following recommendations was NOT made by the Chadha committee?", "options": [{"label": "A", "text": "PHC at block level", "correct": false}, {"label": "B", "text": "One PHC for 50,000 population", "correct": true}, {"label": "C", "text": "One basic health worker per 10,000 population", "correct": false}, {"label": "D", "text": "Responsibility of PHCs in malaria eradication", "correct": false}], "correct_answer": "B. One PHC for 50,000 population", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B: One PHC for 50,000 popu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 10-day-old newborn presents with jaundice, hepatosplenomegaly, microcephaly, diffuse petechiae, and periventricular calcifications . Which of the following will be the best sample for diagnosis in this case?", "options": [{"label": "A", "text": "Urine examination", "correct": true}, {"label": "B", "text": "Liver biopsy", "correct": false}, {"label": "C", "text": "Blood examination", "correct": false}, {"label": "D", "text": "CSF examination", "correct": false}], "correct_answer": "A. Urine examination", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\"&gt;Urine&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following options is not linked to Sprengel deformity?", "options": [{"label": "A", "text": "Diastematomyelia", "correct": false}, {"label": "B", "text": "Klippel-Feil syndrome", "correct": false}, {"label": "C", "text": "Dextrocardia", "correct": true}, {"label": "D", "text": "Congenital scoliosis", "correct": false}], "correct_answer": "C. Dextrocardia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - D\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which one of the subsequent options pertains to a stomach tumor present with acanthosis nigricans?", "options": [{"label": "A", "text": "Carcinoid tumor", "correct": false}, {"label": "B", "text": "Lymphoma", "correct": false}, {"label": "C", "text": "Gastrointestinal stromal tumor", "correct": false}, {"label": "D", "text": "Gastric adenocarcinoma", "correct": true}], "correct_answer": "D. Gastric adenocarcinoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\"&gt;Gastric&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the given fracture?", "options": [{"label": "A", "text": "Colles Fracture", "correct": true}, {"label": "B", "text": "Monteggia Fracture", "correct": false}, {"label": "C", "text": "Galeazzi Fracture", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "A. Colles Fracture", "question_images": ["https://image.prepladder.com/content/htE78AT3uSVNFCygUuIl1700131469.png"], "explanation_images": ["https://image.prepladder.com/content/Uf4tQALoRQWnHSrP7jxo1700131615.png", "https://image.prepladder.com/content/pFBXsR6wKjIRCadcBKQL1700131683.png"], "explanation": "<p>Correct Option A: Colles Fractu\n<table>\n<tbody>\n<tr>\n<td><strong>Definition</strong></td>\n<td>Colles <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">Fracture</span> is a type of <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"ec7c10c0421692777197d151a4c0b5\">radius</span> <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> characterized by a break at the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> end of the <span class=\"customMeta\" data-dictid=\"ec7c10c0421692777197d151a4c0b5\">radius</span> bone in the forearm. It often involves <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">dorsal</span> <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> and <span class=\"customMeta\" data-dictid=\"1aec9f83db16927771815b94ad8e86\">angulation</span> of the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> fragment. Named after the Irish surgeon Abraham Colles.</td>\n</tr>\n<tr>\n<td><strong>Epidemiology</strong></td>\n<td>- Most common type of wrist <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> in adults, particularly in the elderly population. - Often associated with falls onto an outstretched hand.</td>\n</tr>\n<tr>\n<td><strong>Mechanism of Injury</strong></td>\n<td>- Typically occurs due to a fall on an outstretched hand with the wrist extended. - <span class=\"customMeta\" data-dictid=\"01591f7f591692777182ef8aa2360c\">Axial</span> <span class=\"customMeta\" data-dictid=\"00a5dcc74b16927771913b344e36a3\">loading</span> on the <span class=\"customMeta\" data-dictid=\"ec7c10c0421692777197d151a4c0b5\">radius</span> leads to the characteristic <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> pattern.</td>\n</tr>\n<tr>\n<td><strong>Clinical Presentation</strong></td>\n<td>- <strong>Deformity:</strong> <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">Dorsal</span> <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> and \"dinner fork\" or \"bayonet\" <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> may be visible. - <strong>Pain:</strong> <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">Localized</span> pain at the site of the fracture. - <strong>Swelling:</strong> Immediate <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> around the wrist.</td>\n</tr>\n<tr>\n<td><strong>Radiographic Features</strong></td>\n<td>- <strong>Dorsal Tilt:</strong> On X-rays, <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">dorsal</span> <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> and <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">dorsal</span> tilt of the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> fragment are characteristic. - <strong>Radial Shortening:</strong> Shortening of the <span class=\"customMeta\" data-dictid=\"ec7c10c0421692777197d151a4c0b5\">radius</span> may also be observed.</td>\n</tr>\n<tr>\n<td><strong>Classification</strong></td>\n<td>- <strong>Extra-articular (Type I):</strong> <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">Fracture</span> occurs just above the wrist joint. - <strong>Partial <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">Articular</span> (Type II):</strong> <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">Fracture</span> extends into the joint but does not involve the joint surface. - <strong>Complete <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">Articular</span> (Type III):</strong> <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">Fracture</span> extends into the joint and involves the joint surface.</td>\n</tr>\n<tr>\n<td><strong>Treatment</strong></td>\n<td>- <strong>Closed Reduction and Casting:</strong> Common initial approach, especially for less displaced fractures. - <strong>Open Reduction and Internal <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">Fixation</span> (ORIF):</strong> Considered for more complex or displaced fractures, or cases where <span class=\"customMeta\" data-dictid=\"da014870171692777184980beab405\">closed reduction</span> is not successful.</td>\n</tr>\n<tr>\n<td><strong>Complications</strong></td>\n<td>- <strong>Malunion:</strong> Improper <span class=\"customMeta\" data-dictid=\"3c0c325f4216927771819e5d0eb581\">alignment</span> during <span class=\"customMeta\" data-dictid=\"9cf83937931692777188a014337dcf\">healing</span> may lead to deformity. - <strong>Nerve or <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">Vascular</span> Injury:</strong> Rare but possible, especially in more severe fractures.</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is incorrect in relation to the provided image ?", "options": [{"label": "A", "text": "It represents melanocytic hamartoma", "correct": false}, {"label": "B", "text": "It causes no visual disturbance", "correct": false}, {"label": "C", "text": "It is associated with facial angiofibroma", "correct": true}, {"label": "D", "text": "They are diagnostic of a neurocutaneous syndrome", "correct": false}], "correct_answer": "C. It is associated with facial angiofibroma", "question_images": ["https://image.prepladder.com/content/0GZfyDjRLnGS9v707e1M1691498659.png"], "explanation_images": [], "explanation": "<p>Correct Option C - It is associated with &lt;span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\"&gt;facial&lt;/span&gt; ang\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inheritance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Autosomal dominance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Genes involved</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>NF-1 gene on <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> 17</li>\n<li>NF-2 gene on <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> 22</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diagnostic criteria for <span class=\"customMeta\" data-dictid=\"6518acf261169277719312127935af\">neurofibromatosis</span> - 1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Presence of 2 or more of the following:</p>\n<ul>\n<li>Freckling of the axillary or inguinal areas</li>\n<li>Lisch nodules, 2 or more involving the eyes</li>\n<li>Optic <span class=\"customMeta\" data-dictid=\"ce27f87b7d16927771884484964b65\">glioma</span> (most common tumor seen in NF-1)</li>\n<li>First-degree relative affected with same disorder</li>\n<li>Presence of 2 or more neurofibromas</li>\n<li>Presence of 6 or more Caif au lait spots - Significant if the size is &gt;5 mm in prepubertal age and &gt;15 mm in Adolescence</li>\n<li>A distinctive <span class=\"customMeta\" data-dictid=\"83ceeee3151692777194ec61af5c55\">osseous</span> lesion, such as <span class=\"customMeta\" data-dictid=\"32aabfe5711692777199d68bd57d67\">sphenoid</span> <span class=\"customMeta\" data-dictid=\"984733db481692777186757cce6e6b\">dysplasia</span> or thinning of long bone cortex, also known as <span class=\"customMeta\" data-dictid=\"984733db481692777186757cce6e6b\">dysplasia</span> of the <span class=\"customMeta\" data-dictid=\"ddcb80564916927771999af33f90b7\">sphenoidal</span> and <span class=\"customMeta\" data-dictid=\"f2a519f38316927772004fe7c606af\">tibial</span> bone.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the Revised National Tuberculosis Control Programme organization structure, which of the following centres is the furthest from the core?", "options": [{"label": "A", "text": "District TB centre", "correct": false}, {"label": "B", "text": "Intermediate Reference Laboratory", "correct": false}, {"label": "C", "text": "Tuberculosis Unit", "correct": false}, {"label": "D", "text": "Designated Microscopy Centre", "correct": true}], "correct_answer": "D. Designated Microscopy Centre", "question_images": [], "explanation_images": [], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ Sub-Centre: The sub-centre is the first point of contact for healthcare services at the village level.</li><li>↳ Sub-Centre:</li><li>↳ Designated Microscopy Centre (DMC): The DMC is located at the primary healthcare level, such as a Primary Health Centre (PHC) or a sub-district level health facility.</li><li>↳ Designated Microscopy Centre (DMC):</li><li>↳ Primary Health Centre (PHC): The PHC is a higher-level primary healthcare facility that serves as a referral center for sub-centres.</li><li>↳ Primary Health Centre (PHC):</li><li>↳ Community Health Centre (CHC): The CHC is a secondary level healthcare facility that serves as a referral center for PHCs.</li><li>↳ Community Health Centre (CHC):</li><li>↳ District TB Centre (DTC): The DTC is responsible for overseeing and coordinating TB control activities at the district level. (Option A)</li><li>↳ District TB Centre (DTC):</li><li>↳ (Option A)</li><li>↳ Intermediate Reference Laboratory (IRL): The IRL is typically located at the state or regional level. (Option B)</li><li>↳ Intermediate Reference Laboratory (IRL):</li><li>↳ (Option B)</li><li>↳ Tuberculosis Unit (Option C): The Tuberculosis Unit refers to a health unit or department that is responsible for the diagnosis, treatment, and management of TB patients.</li><li>↳ Tuberculosis Unit (Option C):</li></u\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most common presentation of congenital adrenal hyperplasia?", "options": [{"label": "A", "text": "Male pseudohermaphroditism", "correct": false}, {"label": "B", "text": "Female pseudohermaphroditism", "correct": true}, {"label": "C", "text": "True hermaphroditism", "correct": false}, {"label": "D", "text": "46, XY intersex", "correct": false}], "correct_answer": "B. Female pseudohermaphroditism", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Female pseudohermaph\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:567px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Enzyme deficiency</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mineralocorticoids</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>K+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>BP</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cortisol</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sex hormone</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Presentation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>17α-hydroxylase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>XY: <span class=\"customMeta\" data-dictid=\"06123ff61a1692777182e19b790ebc\">Atypical</span> genitalia, undescended testes</p>\n<p>XX: Lacks secondary sexual development</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>21-hydroxylase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Most common</p>\n<p>Present in <span class=\"customMeta\" data-dictid=\"663d16ec8e169277719095f74c9816\">infancy</span> (salt wasting) or childhood (precocious puberty)</p>\n<p>XX: Virilization</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>11β-hydroxylase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↓aldosterone</p>\n<p>↑11-deoxycorticosterone</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present in <span class=\"customMeta\" data-dictid=\"663d16ec8e169277719095f74c9816\">infancy</span> (severe hypertension) or childhood (precocious puberty)</p>\n<p>XX: Virilization</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with a history of a road traffic accident 2 years back, and has developed pain and swelling now at the same site . His X-ray image is shown in the image given below. What is the probable diagnosis?", "options": [{"label": "A", "text": "Osteogenic sarcoma", "correct": false}, {"label": "B", "text": "Ewing's sarcoma", "correct": false}, {"label": "C", "text": "Chronic osteomyelitis", "correct": true}, {"label": "D", "text": "Multiple myeloma", "correct": false}], "correct_answer": "C. Chronic osteomyelitis", "question_images": ["https://image.prepladder.com/content/KQNWyhIhJPw6RcNlRwN71700216744.png"], "explanation_images": [], "explanation": "<p>Correct Option C - Chronic O\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the maximum duration for TRALI to occur after a blood transfusion?", "options": [{"label": "A", "text": "12 hours", "correct": false}, {"label": "B", "text": "24 hours", "correct": false}, {"label": "C", "text": "6 hours", "correct": true}, {"label": "D", "text": "48 hours", "correct": false}], "correct_answer": "C. 6 hours", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option C: 6 hou\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the statements below is correct regarding the Factories Act?", "options": [{"label": "A", "text": "Children under 14 years of age must not be employed in factories", "correct": true}, {"label": "B", "text": "A child of 16 years can be employed only between 6 AM and 8 PM", "correct": false}, {"label": "C", "text": "The maximum working hours for an adult is 72 hours per week", "correct": false}, {"label": "D", "text": "A child of 16 years can work till 5 hours per day", "correct": false}], "correct_answer": "A. Children under 14 years of age must not be employed in factories", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A: Children under 14 years of age mu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old male patient presents with a past medical record of discomfort in the musculoskeletal system. Which of the subsequent options indicates that the pain is not related to the joints?", "options": [{"label": "A", "text": "Swelling", "correct": false}, {"label": "B", "text": "Pain in both movement and at rest", "correct": false}, {"label": "C", "text": "Painless on passive movement", "correct": true}, {"label": "D", "text": "Presence of crepitation", "correct": false}], "correct_answer": "C. Painless on passive movement", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Painless on &lt;span class=\"customMeta\" data-dictid=\"c72d29ec4116927771942153c0d252\"&gt;passive&lt;/span&gt; mov\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Diagnosis</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Osteoarthritis</strong></p>\n</td>\n<td>\n<p>Degenerative joint disease characterized by the <span class=\"customMeta\" data-dictid=\"903370f259169277718385f6060dd7\">breakdown</span> of <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">cartilage</span> and subsequent joint pain and stiffness</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Rheumatoid arthritis</strong></p>\n</td>\n<td>\n<p>Autoimmune disease causing <span class=\"customMeta\" data-dictid=\"e025d338b21692777184b4a309cbfb\">chronic inflammation</span> of the joints, leading to pain, swelling, and joint deformity</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Gout</strong></p>\n</td>\n<td>\n<p>Inflammatory <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">arthritis</span> caused by the buildup of <span class=\"customMeta\" data-dictid=\"ffa20262931692777201caef35de16\">uric</span> acid crystals in the joints, resulting in sudden and severe pain</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Fibromyalgia</strong></p>\n</td>\n<td>\n<p>Chronic condition characterized by widespread <span class=\"customMeta\" data-dictid=\"09b955b4f91692777193bd4080e7fc\">musculoskeletal</span> pain, fatigue, and <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> at specific trigger points</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Bursitis</strong></p>\n</td>\n<td>\n<p>Inflammation of the bursae, fluid-filled sacs that <span class=\"customMeta\" data-dictid=\"f4ac509de71692777185c1d0700a8b\">cushion</span> and reduce <span class=\"customMeta\" data-dictid=\"468709afe3169277720301878d09fd\">friction</span> between bones, tendons, and muscles</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Tendinitis</strong></p>\n</td>\n<td>\n<p>Inflammation of a tendon, often caused by overuse or repetitive motion, resulting in <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> pain and tenderness</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Muscular strain or sprain</strong></p>\n</td>\n<td>\n<p>Injury to muscles or ligaments due to overstretching or tearing, leading to pain, swelling, and limited range of motion</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Stress fractures</strong></p>\n</td>\n<td>\n<p>Small cracks or breaks in bones, usually caused by repetitive stress or overuse, resulting in <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> pain and swelling</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Herniated disc</strong></p>\n</td>\n<td>\n<p>Condition where the soft inner material of a <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> disc leaks through the outer layer, causing nerve <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> and pain</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Sciatica</strong></p>\n</td>\n<td>\n<p>Pain radiating along the path of the <span class=\"customMeta\" data-dictid=\"1cb6159469169277719843ab627a07\">sciatic</span> nerve, often caused by <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> or <span class=\"customMeta\" data-dictid=\"3a74ed0fcf16927771901a79847565\">irritation</span> of the nerve</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the characteristic sign of a simple bone cyst?", "options": [{"label": "A", "text": "Fallen fragment sign", "correct": true}, {"label": "B", "text": "Scalloping of cortex", "correct": false}, {"label": "C", "text": "Never breaches physis", "correct": false}, {"label": "D", "text": "Central radiolucent lesion", "correct": false}], "correct_answer": "A. Fallen fragment sign", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/BuMGoBzhpxcXj5C14uEN1718084976.png"], "explanation": "<p>Correct Option A - Fallen Fragment Sig\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a newborn who has a patch of hair on the lower back region ?", "options": [{"label": "A", "text": "Spina bifida occulta", "correct": true}, {"label": "B", "text": "Neurofibromatosis type 1", "correct": false}, {"label": "C", "text": "Tethered spinal cord", "correct": false}, {"label": "D", "text": "Congenital dermal sinus", "correct": false}], "correct_answer": "A. Spina bifida occulta", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "As per the recommended dietary allowance, what is the prescribed dosage of iodine for lactating women in India?", "options": [{"label": "A", "text": "200 μg/day", "correct": false}, {"label": "B", "text": "220 μg/day", "correct": false}, {"label": "C", "text": "250 μg/day", "correct": false}, {"label": "D", "text": "280 μg/day", "correct": true}], "correct_answer": "D. 280 μg/day", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D: 280 μg\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Age Group</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Recommended Dietary <span class=\"customMeta\" data-dictid=\"f8330e788f16927771812e4f73b80c\">Allowance</span> (RDA) of Iodine</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Infants (0-6 months)</p>\n</td>\n<td>\n<p>90 micrograms per day</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Infants (7-12 months)</p>\n</td>\n<td>\n<p>90 micrograms per day</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Children (1-9 years)</p>\n</td>\n<td>\n<p>90 micrograms per day</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Children (10-12 years)</p>\n</td>\n<td>\n<p>120 micrograms per day</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Adolescents (boys and girls 13-18 years)</p>\n</td>\n<td>\n<p>150 micrograms per day</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Adults (men and non-pregnant women)</p>\n</td>\n<td>\n<p>150 micrograms per day</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Pregnant women</p>\n</td>\n<td>\n<p>250 micrograms per day</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Lactating women</p>\n</td>\n<td>\n<p>280 micrograms per day</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is incorrect about perilunate dislocation ?", "options": [{"label": "A", "text": "Lunate is dislocated anteriorly but the rest of the carpals remains in position", "correct": true}, {"label": "B", "text": "Lunate remains in position but rest other dislocate dorsally", "correct": false}, {"label": "C", "text": "Involves median nerve injury", "correct": false}, {"label": "D", "text": "Tavernier's manoeuvre is used for closed reduction", "correct": false}], "correct_answer": "A. Lunate is dislocated anteriorly but the rest of the carpals remains in position", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"2c800b393f1692777191e260e94f78\"&gt;Lunate&lt;/span&gt; is dislocated anteriorly but the rest of th\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In newborns, what is the primary cause of ventriculomegaly?", "options": [{"label": "A", "text": "Arnold-Chiari malformation", "correct": false}, {"label": "B", "text": "Dandy-Walker syndrome", "correct": false}, {"label": "C", "text": "Arachnoid Villi malformation", "correct": false}, {"label": "D", "text": "Aqueductal stenosis", "correct": true}], "correct_answer": "D. Aqueductal stenosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D: Aquedu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "When do you consider administering epinephrine to a neonate during resuscitation?", "options": [{"label": "A", "text": "Heart rate remains at &amp;lt; 60 beats/minute despite effective compressions and ventilations", "correct": true}, {"label": "B", "text": "Heart rate remains at &amp;lt; 100 beats/minute despite effective compressions and ventilations", "correct": false}, {"label": "C", "text": "Heart rate does not improve after 30 seconds with bag and mask ventilation", "correct": false}, {"label": "D", "text": "Infants with severe respiratory depression fail respond to positive-pressure ventilation via bag and mask", "correct": false}], "correct_answer": "A. Heart rate remains at &lt; 60 beats/minute despite effective compressions and ventilations", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/DxEqLffNNwqIco3RButI1713417054.jpg"], "explanation": "<p>Correct option A: Heart rate remains at &amp;lt; 60 beats/minute despite effective compressions and v\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements accurately describes non-parametric tests?", "options": [{"label": "A", "text": "ANOVA is an example of a non-parametric test", "correct": false}, {"label": "B", "text": "It is used for skewed distributions", "correct": true}, {"label": "C", "text": "It involves the assumption that the data has a normal distribution", "correct": false}, {"label": "D", "text": "It cannot be used for small sample sizes", "correct": false}], "correct_answer": "B. It is used for skewed distributions", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B: It is used for skewed distribu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Prolonged bleeding time is seen in:", "options": [{"label": "A", "text": "Hemophilia A", "correct": false}, {"label": "B", "text": "Hemophilia B", "correct": false}, {"label": "C", "text": "Von Willebrand disease", "correct": true}, {"label": "D", "text": "Both A and B", "correct": false}], "correct_answer": "C. Von Willebrand disease", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Von Willebrand D\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td> </td>\n<td><strong>Platelet count</strong></td>\n<td><strong>BT</strong></td>\n<td><strong>PTT</strong></td>\n<td><strong>aPTT</strong></td>\n</tr>\n<tr>\n<td><strong>Bernard-Soulier syndrome</strong></td>\n<td>Normal</td>\n<td>Elevated</td>\n<td>Normal</td>\n<td>Normal</td>\n</tr>\n<tr>\n<td><strong>Glanzmann thrombasthenia</strong></td>\n<td>Normal</td>\n<td>Elevated</td>\n<td>Normal</td>\n<td>Normal</td>\n</tr>\n<tr>\n<td><strong>ITP</strong></td>\n<td>Low</td>\n<td>Elevated</td>\n<td>Normal</td>\n<td>Normal</td>\n</tr>\n<tr>\n<td><strong>Hemophilia A</strong></td>\n<td>Normal</td>\n<td>Normal</td>\n<td>Normal</td>\n<td>Elevated</td>\n</tr>\n<tr>\n<td><strong>Hemophilia B</strong></td>\n<td>Normal</td>\n<td>Normal</td>\n<td>Normal</td>\n<td>Elevated</td>\n</tr>\n<tr>\n<td><strong>HUS / TTP</strong></td>\n<td>Low</td>\n<td>Elevated</td>\n<td>Normal</td>\n<td>Normal</td>\n</tr>\n<tr>\n<td><strong>DIC</strong></td>\n<td>Low</td>\n<td>Elevated</td>\n<td>Elevated</td>\n<td>Elevated</td>\n</tr>\n<tr>\n<td><strong>vWD</strong></td>\n<td>Normal</td>\n<td>Elevated</td>\n<td>Normal</td>\n<td>Elevated</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the carpal bone that is most commonly fractured after fall on an outstretched hand .", "options": [{"label": "A", "text": "A", "correct": true}, {"label": "B", "text": "C", "correct": false}, {"label": "C", "text": "B", "correct": false}, {"label": "D", "text": "D", "correct": false}], "correct_answer": "A. A", "question_images": ["https://image.prepladder.com/content/wS337L07Z3aiXFthXw1F1713873361.png"], "explanation_images": ["https://image.prepladder.com/content/AMhCKi7wozIft1mQwVZx1713873389.png", "https://image.prepladder.com/content/EwCUcuHzFu3ZySHWocja1713873405.png"], "explanation": "<p>Correct Option A - A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements about ataxia telangiectasia is false?", "options": [{"label": "A", "text": "Mutations in 11q gene is implicated", "correct": false}, {"label": "B", "text": "Follows autosomal dominant mode of inheritance", "correct": true}, {"label": "C", "text": "Humoral and cellular immunodeficiency", "correct": false}, {"label": "D", "text": "Linked to adenocarcinomas", "correct": false}], "correct_answer": "B. Follows autosomal dominant mode of inheritance", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Follows autosomal dominant mode of inh\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which specific article in the Indian constitution grants the Right to Life to the residents of India?", "options": [{"label": "A", "text": "Article 11", "correct": false}, {"label": "B", "text": "Article 21", "correct": true}, {"label": "C", "text": "Article 23", "correct": false}, {"label": "D", "text": "Article 25", "correct": false}], "correct_answer": "B. Article 21", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "For hypertrophic non-union following a fracture, the most appropriate treatment", "options": [{"label": "A", "text": "Stabilization", "correct": true}, {"label": "B", "text": "Bone grafting", "correct": false}, {"label": "C", "text": "Stabilization and bone grafting", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "A. Stabilization", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A: S\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Warthin-Finkeldey cells are seen in?", "options": [{"label": "A", "text": "Rubella", "correct": false}, {"label": "B", "text": "Rubeola", "correct": true}, {"label": "C", "text": "Rabies", "correct": false}, {"label": "D", "text": "Typhoid", "correct": false}], "correct_answer": "B. Rubeola", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/izoXaW1pvlJFOWS45vtD1714038942.png"], "explanation": "<p>Correct Option B - Ru\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What immunization coverage percentage is required by the WHO for the eradication of measles?", "options": [{"label": "A", "text": "68%", "correct": false}, {"label": "B", "text": "72%", "correct": false}, {"label": "C", "text": "84%", "correct": false}, {"label": "D", "text": "96%", "correct": true}], "correct_answer": "D. 96%", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D- 96%\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the subsequent conditions is characteristic of an X-linked disorder?", "options": [{"label": "A", "text": "Color blindness", "correct": true}, {"label": "B", "text": "Thalassemia", "correct": false}, {"label": "C", "text": "Sickle cell anemia", "correct": false}, {"label": "D", "text": "Cystic fibrosis", "correct": false}], "correct_answer": "A. Color blindness", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - C\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-Linked Disorders</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Autosomal <span class=\"customMeta\" data-dictid=\"d54db2110416927771971e7c011a9f\">Recessive</span> Disorders</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Autosomal Dominant Disorders</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Duchenne <span class=\"customMeta\" data-dictid=\"9e2d8a3f5a16927771932c2348ec52\">Muscular</span> Dystrophy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cystic Fibrosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Huntington's Disease</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hemophilia A</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Phenylketonuria (PKU)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Marfan Syndrome</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Color Blindness</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sickle Cell Anemia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Neurofibromatosis Type 1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fragile X Syndrome</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tay-Sachs Disease</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Polycystic <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">Kidney</span> Disease</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Becker <span class=\"customMeta\" data-dictid=\"9e2d8a3f5a16927771932c2348ec52\">Muscular</span> Dystrophy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gaucher Disease</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hereditary Hemochromatosis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following parameters in Acute Lymphoblastic Leukemia (ALL) indicates an unfavorable prognosis?", "options": [{"label": "A", "text": "Age &amp;gt; 10 years", "correct": true}, {"label": "B", "text": "Leukocyte count &amp;lt; 50,000/mm3", "correct": false}, {"label": "C", "text": "Hyperdiploidy", "correct": false}, {"label": "D", "text": "Trisomy of chromosomes 4, 10, and 17", "correct": false}], "correct_answer": "A. Age &gt; 10 years", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Age &amp;g\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Characteristic</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Good</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bad</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Age</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2-9 years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≤ 1 years or ≥ 10 years</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gender</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Females</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Males</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>FAB</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>L1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>L3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cytogenetics</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>t (12;21)</li>\n<li>Hyperploidy</li>\n<li>Trisomy 4,10,17</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>t (5;14)</li>\n<li>t (9;22)</li>\n<li>Hypoploidy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Phenotypically</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Early pre-B-cells</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mature B cells, T cells</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Time to remission</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≤14 days</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≥28 days</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>MRD (Minimal <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">Residual</span> Disease)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt; 0.01 %</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;0.01%</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The predominant organ producing insulin-like growth factor I is", "options": [{"label": "A", "text": "Liver", "correct": true}, {"label": "B", "text": "Pituitary gland", "correct": false}, {"label": "C", "text": "Pancreas", "correct": false}, {"label": "D", "text": "Adrenal glands", "correct": false}], "correct_answer": "A. Liver", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A: Liv\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements correctly describes the findings of a well-designed cancer study that obtained similar remission rates of 33.2% for both a new treatment and the usual treatment, with a p-value of 0.04?", "options": [{"label": "A", "text": "Both the treatments are equally effective", "correct": false}, {"label": "B", "text": "Neither of the treatments is effective", "correct": false}, {"label": "C", "text": "The new treatment is more effective than the usual treatment", "correct": true}, {"label": "D", "text": "The information given is not adequate to compare the efficacy of the treatments", "correct": false}], "correct_answer": "C. The new treatment is more effective than the usual treatment", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - The new treatment is more effective than the usual treatment.\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the single most important long-term limitation of cardiac transplantation?", "options": [{"label": "A", "text": "Allograft rejection", "correct": false}, {"label": "B", "text": "Allograft arteriopathy", "correct": true}, {"label": "C", "text": "Infection", "correct": false}, {"label": "D", "text": "Malignancy", "correct": false}], "correct_answer": "B. Allograft arteriopathy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"44d3120c8f16927771815478ab1d1f\"&gt;Allograft&lt;/span&gt; Arteriopath\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the viral infection that can lead to temporary aplastic anemia?", "options": [{"label": "A", "text": "HIV", "correct": false}, {"label": "B", "text": "Polio", "correct": false}, {"label": "C", "text": "Parvovirus B-19", "correct": true}, {"label": "D", "text": "HHV-8", "correct": false}], "correct_answer": "C. Parvovirus B-19", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"4c37b9980316927771941adbff3e43\"&gt;Parvovirus&lt;/span&gt; B-19\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is Prosopagnosia?", "options": [{"label": "A", "text": "Impairment of consciousness", "correct": false}, {"label": "B", "text": "Being unaware of one’s problems", "correct": false}, {"label": "C", "text": "Difficulty in identifying known faces", "correct": true}, {"label": "D", "text": "Failure to identify objects", "correct": false}], "correct_answer": "C. Difficulty in identifying known faces", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Difficulty in identifying k\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What are the accurate characteristics of ovotesticular disorders of sex development?", "options": [{"label": "A", "text": "Karyotype is 46 XY.", "correct": false}, {"label": "B", "text": "Ovotesticular disorder of sex development can be identified in the gonadal biopsy", "correct": true}, {"label": "C", "text": "The response of testosterone to hCG is increased.", "correct": false}, {"label": "D", "text": "Uterus is usually absent.", "correct": false}], "correct_answer": "B. Ovotesticular disorder of sex development can be identified in the gonadal biopsy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Ovotesticular disorder of sex development can be identified in the g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which chromosome is involved in myotonic dystrophy?", "options": [{"label": "A", "text": "Chromosome 19", "correct": true}, {"label": "B", "text": "Chromosome 20", "correct": false}, {"label": "C", "text": "Chromosome 21", "correct": false}, {"label": "D", "text": "Chromosome 22", "correct": false}], "correct_answer": "A. Chromosome 19", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\"&gt;Chromosome&lt;/span&gt; 19\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/wLSJEQOCLWIBiMpXdWlB1748415126.mp3", "video": ""}, {"text": "Which of the following components is not responsible for the countercurrent multiplier mechanism in the kidney ?", "options": [{"label": "A", "text": "Sodium outflow in thick ascending limb", "correct": false}, {"label": "B", "text": "Water outflow in thin descending limb", "correct": false}, {"label": "C", "text": "Sodium outflow in thin ascending limb", "correct": false}, {"label": "D", "text": "Flow of tubular fluid from PCT to DCT", "correct": true}], "correct_answer": "D. Flow of tubular fluid from PCT to DCT", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Flow of &lt;span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\"&gt;tubular&lt;/span&gt; fluid from &lt;span class=\"customMeta\" data-dictid=\"406aede9e21692777194b4cefe9958\"&gt;PCT&lt;/span&gt; to DCT\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not part of the criteria for diagnosing neurofibromatosis 1 ?", "options": [{"label": "A", "text": "Two or more iris hamartomas", "correct": false}, {"label": "B", "text": "Acoustic neuromas", "correct": true}, {"label": "C", "text": "Dysplasia of the sphenoidal and tibial bone", "correct": false}, {"label": "D", "text": "Cafe-au-lait spots", "correct": false}], "correct_answer": "B. Acoustic neuromas", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"54d290087e1692777180c6cc682930\"&gt;Acoustic&lt;/span&gt; neu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the appropriate treatment for a 9-month-old infant experiencing diarrhea, who is consuming food adequately and displaying signs of thirst , with skin returning to normal within 2 seconds after being pinched?", "options": [{"label": "A", "text": "200-400 ml of ORS to be given in the first four hours.", "correct": false}, {"label": "B", "text": "400-700 ml of ORS to be given in the first four hours.", "correct": true}, {"label": "C", "text": "700-900 ml of ORS to be given in the first four hours.", "correct": false}, {"label": "D", "text": "In addition to the usual fluid intake, 100-200 ml should be given after each loose stool.", "correct": false}], "correct_answer": "B. 400-700 ml of ORS to be given in the first four hours.", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - 400-700 ml of &lt;span class=\"customMeta\" data-dictid=\"dba8ab2e8416927771945fed398293\"&gt;ORS&lt;/span&gt; to be given in the first four hou\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td><strong>Weight</strong></td>\n<td>&lt;6 kg</td>\n<td>6-10 kg</td>\n<td>10-12 kg</td>\n<td>12-19 kg</td>\n</tr>\n<tr>\n<td><strong>Age</strong></td>\n<td>Up to 4 months</td>\n<td>4-12 months</td>\n<td>12 months-2 years</td>\n<td>2-5 years</td>\n</tr>\n<tr>\n<td><strong>In ml</strong></td>\n<td>200-450</td>\n<td>450-800</td>\n<td>800-960</td>\n<td>960-1600</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Cowden syndrome is associated with mutations in:", "options": [{"label": "A", "text": "PTEN", "correct": true}, {"label": "B", "text": "WT1", "correct": false}, {"label": "C", "text": "p53", "correct": false}, {"label": "D", "text": "RAS", "correct": false}], "correct_answer": "A. PTEN", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A: PTEN\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Glucose is absorbed in the intestine by?", "options": [{"label": "A", "text": "Primary active transport", "correct": false}, {"label": "B", "text": "Facilitated diffusion", "correct": false}, {"label": "C", "text": "Simple diffusion", "correct": false}, {"label": "D", "text": "Secondary active transport", "correct": true}], "correct_answer": "D. Secondary active transport", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/7B2qO0jbFXYhyWndF65g1718340020.png"], "explanation": "<p>Correct Option D: Secondary activ\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What BMI value is generally considered extremely low and associated with a higher risk of severe health complications in men? a. BMI &amp;lt; 10 b. BMI &amp;lt; 15 c. d.", "options": [{"label": "A", "text": "BMI &amp;lt; 15", "correct": true}, {"label": "B", "text": "BMI &amp;lt; 20", "correct": false}, {"label": "C", "text": "BMI &amp;lt; 25", "correct": false}, {"label": "D", "text": "BMI &amp;lt; 30", "correct": false}], "correct_answer": "A. BMI &lt; 15", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>BMI Range (kg/m²)</strong></p>\n</td>\n<td>\n<p><strong>Classification</strong></p>\n</td>\n<td>\n<p><strong>Men</strong></p>\n</td>\n<td>\n<p><strong>Women</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Below 16.0</p>\n</td>\n<td>\n<p>Severe malnutrition</p>\n</td>\n<td>\n<p>Below 16.0</p>\n</td>\n<td>\n<p>Below 16.0</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>16.0 - 16.9</p>\n</td>\n<td>\n<p>Moderate malnutrition</p>\n</td>\n<td>\n<p>16.0 - 16.9</p>\n</td>\n<td>\n<p>16.0 - 16.9</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>17.0 - 18.4</p>\n</td>\n<td>\n<p>Mild malnutrition</p>\n</td>\n<td>\n<p>17.0 - 18.4</p>\n</td>\n<td>\n<p>17.0 - 18.4</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>18.5 - 24.9</p>\n</td>\n<td>\n<p>Normal weight</p>\n</td>\n<td>\n<p>18.5 - 24.9</p>\n</td>\n<td>\n<p>18.5 - 24.9</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>25.0 - 29.9</p>\n</td>\n<td>\n<p>Overweight</p>\n</td>\n<td>\n<p>25.0 - 29.9</p>\n</td>\n<td>\n<p>25.0 - 29.9</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>30.0 - 34.9</p>\n</td>\n<td>\n<p>Obesity Class I</p>\n</td>\n<td>\n<p>30.0 - 34.9</p>\n</td>\n<td>\n<p>30.0 - 34.9</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>35.0 - 39.9</p>\n</td>\n<td>\n<p>Obesity Class II</p>\n</td>\n<td>\n<p>35.0 - 39.9</p>\n</td>\n<td>\n<p>35.0 - 39.9</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>40.0 and above</p>\n</td>\n<td>\n<p>Obesity Class III</p>\n</td>\n<td>\n<p>40.0 and above</p>\n</td>\n<td>\n<p>40.0 and above</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most common cause of agranulocytosis?", "options": [{"label": "A", "text": "Marrow infiltration", "correct": false}, {"label": "B", "text": "Autoimmune", "correct": false}, {"label": "C", "text": "Drug toxicity", "correct": true}, {"label": "D", "text": "Radiation exposure", "correct": false}], "correct_answer": "C. Drug toxicity", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Drug\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not employed in evaluating body fat?", "options": [{"label": "A", "text": "Quetelet’s index", "correct": false}, {"label": "B", "text": "Total body potassium", "correct": false}, {"label": "C", "text": "Total body water", "correct": false}, {"label": "D", "text": "Breslow index", "correct": true}], "correct_answer": "D. Breslow index", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D: B\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Assessment Method</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>BODY FAT ASSESSMENT</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Body Mass Index (BMI)</strong></p>\n</td>\n<td>\n<p>Calculated by dividing an individual's weight (in kilograms) by the square of their height (in meters).</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Dual-Energy <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> <span class=\"customMeta\" data-dictid=\"535c34a5c516927771801ee5909c2e\">Absorptiometry</span> (DXA)</strong></p>\n</td>\n<td>\n<p>A precise method that measures body composition, including bone mineral density, lean mass, and fat mass, using low-dose X-rays.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Skinfold <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">Thickness</span> Measurement</strong></p>\n</td>\n<td>\n<p>Measures the <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> of <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> fat at specific sites on the body using calipers.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Bioelectrical <span class=\"customMeta\" data-dictid=\"5506888d131692777189948dbb6f26\">Impedance</span> Analysis (BIA)</strong></p>\n</td>\n<td>\n<p>Uses electrical <span class=\"customMeta\" data-dictid=\"5506888d131692777189948dbb6f26\">impedance</span> to estimate body composition. A low-level electrical current is passed through the body, measuring resistance.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Air <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">Displacement</span> <span class=\"customMeta\" data-dictid=\"5e7bc7da6d16927771950fcdea984a\">Plethysmography</span> (ADP)</strong></p>\n</td>\n<td>\n<p>Involves measuring body volume and density by sitting inside a small chamber that uses air displacement.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Hydrostatic Weighing</strong></p>\n</td>\n<td>\n<p>Determines body density by measuring a person's weight while submerged underwater.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Near-Infrared Interactance</strong></p>\n</td>\n<td>\n<p>Measures the reflection and <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> of near-infrared light to estimate body fat content.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Waist Circumference</strong></p>\n</td>\n<td>\n<p>Measures the <span class=\"customMeta\" data-dictid=\"0e190b1ed716927771848781259060\">circumference</span> of the waist, providing an <span class=\"customMeta\" data-dictid=\"2f73e160ba1692777190d65065c95b\">indirect</span> indicator of <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> fat and health risks.</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the proportion of disease occurrence in the exposed population compared to the non-exposed population?", "options": [{"label": "A", "text": "Attributable risk", "correct": false}, {"label": "B", "text": "Odds ratio", "correct": false}, {"label": "C", "text": "Relative risk", "correct": true}, {"label": "D", "text": "Population attributable risk", "correct": false}], "correct_answer": "C. Relative risk", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Relative risk\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/SJH4q4x0ukfCBOvxQ8Nw1746258461.mp3", "video": ""}, {"text": "All of these are characteristic features of pancreatic carcinoma , except :", "options": [{"label": "A", "text": "Cigarette smoking is a risk factor", "correct": false}, {"label": "B", "text": "Carcinoma of body pancreas often present with jaundice", "correct": true}, {"label": "C", "text": "They elicit intense desmoplastic response", "correct": false}, {"label": "D", "text": "Perineural invasion is common", "correct": false}], "correct_answer": "B. Carcinoma of body pancreas often present with jaundice", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\"&gt;Carcinoma&lt;/span&gt; of body &lt;span class=\"customMeta\" data-dictid=\"2e2fe8c6c116927771946fb9a8adb0\"&gt;pancreas&lt;/span&gt; often present with jau\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What should be the minimum rate of couple protection in order to achieve the demographic target of NRR = 1? NRR: Net Reproduction Rate", "options": [{"label": "A", "text": "50%", "correct": false}, {"label": "B", "text": "40%", "correct": false}, {"label": "C", "text": "70%", "correct": false}, {"label": "D", "text": "60%", "correct": true}], "correct_answer": "D. 60%", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D: 60%\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Stellate granuloma is seen in:", "options": [{"label": "A", "text": "Sarcoidosis", "correct": false}, {"label": "B", "text": "Cat-scratch disease", "correct": true}, {"label": "C", "text": "Cryptococcosis", "correct": false}, {"label": "D", "text": "Histoplasmosis", "correct": false}], "correct_answer": "B. Cat-scratch disease", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/leIsZy4OSQWYDehV0Pqw1712309772.png", "https://image.prepladder.com/content/leIsZy4OSQWYDehV0Pqw1712309772.png"], "explanation": "<p>Correct Option B - Cat-scratch\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/CEnX13Vk31XjXkiJiJLm1747055594.mp3", "video": ""}, {"text": "What is the name of the recently introduced online software by the Indian government, as part of the national tuberculosis elimination program (NTEP), for the purpose of monitoring patients with tuberculosis?", "options": [{"label": "A", "text": "NIKSHAY", "correct": true}, {"label": "B", "text": "NISCHAY", "correct": false}, {"label": "C", "text": "E-DOTS", "correct": false}, {"label": "D", "text": "NIKUSTH", "correct": false}], "correct_answer": "A. NIKSHAY", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/WtNbfsLSil1dFFEttHmN1715061425.png"], "explanation": "<p>Correct Option A - NIKSHAY\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "How are cytotoxic and expired drugs typically disposed of?", "options": [{"label": "A", "text": "Dumping", "correct": false}, {"label": "B", "text": "Autoclave", "correct": false}, {"label": "C", "text": "Incineration", "correct": true}, {"label": "D", "text": "Chemical disinfection", "correct": false}], "correct_answer": "C. Incineration", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C: I\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A colonoscopy of an elderly patient revealed brownish pigmented lesions as shown below. He admitted to chronic laxative abuse. Which of the following laxatives is most likely to cause this condition?", "options": [{"label": "A", "text": "Bran", "correct": false}, {"label": "B", "text": "Psylium", "correct": false}, {"label": "C", "text": "Senna", "correct": true}, {"label": "D", "text": "Methylcellulose", "correct": false}], "correct_answer": "C. Senna", "question_images": ["https://image.prepladder.com/content/cK998W7kpzF2RXfhUNgM1715854985.PNG"], "explanation_images": [], "explanation": "<p>Correct Option C - S\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a population of 1000 individuals, a screening test was conducted for DM (diabetes mellitus). It showed that 90 individuals tested positive for DM. Subsequently, a gold standard test for DM was conducted, and it showed that 100 individuals tested positive. Your task is to determine the sensitivity of the screening test.", "options": [{"label": "A", "text": "90/100", "correct": true}, {"label": "B", "text": "100/110", "correct": false}, {"label": "C", "text": "(90-10)/1000", "correct": false}, {"label": "D", "text": "90/1000", "correct": false}], "correct_answer": "A. 90/100", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/cHOewyNpii2QGyQy9Qn61713784334.png", "https://image.prepladder.com/content/N2LgektXdXSh0sVdeXj91713784328.png"], "explanation": "<p>Correct Option A - 9\n<p><strong>References:</strong></p>\n<ul><li>↳ Sensitivity of a screening test is a measure that indicates the proportion of true positive results correctly identified by the test. It quantifies the test's ability to correctly detect individuals who have the condition or disease being screened for.</li><li>↳ The sensitivity is calculated using the following formula:</li><li>↳ Sensitivity = True Positives / (True Positives + False Negatives)</li><li>↳ True positives refer to the number of individuals who have the condition or disease and are correctly identified as positive by the screening test. False negatives refer to the number of individuals who have the condition or disease but are incorrectly identified as negative by the screening test.</li><li>↳ To calculate the sensitivity, you need the values of true positives and false negatives. These values can be obtained by comparing the results of the screening test to a reference standard or gold standard test.</li><li>↳ For example, if out of 100 individuals who truly have the disease, the screening test correctly identifies 80 as positive (true positives) and misses 20 (false negatives), the sensitivity would be:</li><li>↳ Sensitivity = 80 / (80 + 20) = 80 / 100 = 0.8 or 80%</li><li>↳ So, in this case, the sensitivity of the screening test would be 80%.</li></u\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient who is on treatment for angina, presents to you with erectile dysfunction. You decide against prescribing sildenafil because the patient is being treated with ____________:", "options": [{"label": "A", "text": "Calcium channel blockers", "correct": false}, {"label": "B", "text": "Beta blockers", "correct": false}, {"label": "C", "text": "Nitrates", "correct": true}, {"label": "D", "text": "ACE inhibitors", "correct": false}], "correct_answer": "C. Nitrates", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - N\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the prevalence of a disease with an average duration of 2 years, when the incidence is 4 per 1000 of the population?", "options": [{"label": "A", "text": "8/100", "correct": false}, {"label": "B", "text": "2/1000", "correct": false}, {"label": "C", "text": "4/1000", "correct": false}, {"label": "D", "text": "8/1000", "correct": true}], "correct_answer": "D. 8/1000", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/aeexBSl2ngpx3RTUEqxP1746258649.mp3", "video": ""}, {"text": "An example of a bacteriostatic drug is ________________:", "options": [{"label": "A", "text": "Aminoglycoside", "correct": false}, {"label": "B", "text": "Vancomycin", "correct": false}, {"label": "C", "text": "Metronidazole", "correct": false}, {"label": "D", "text": "Linezolid", "correct": true}], "correct_answer": "D. Linezolid", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - L\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Bacteriostatic Drugs</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Bactericidal Drugs</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Tetracycline</p>\n</td>\n<td>\n<p>Penicillin</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Macrolides (e.g., erythromycin)</p>\n</td>\n<td>\n<p>Cephalosporins</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Clindamycin</p>\n</td>\n<td>\n<p>Fluoroquinolones (e.g., ciprofloxacin)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Chloramphenicol</p>\n</td>\n<td>\n<p>Aminoglycosides (e.g., gentamicin)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Sulfonamides (e.g., trimethoprim-sulfamethoxazole)</p>\n</td>\n<td>\n<p>Vancomycin</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Linezolid</p>\n</td>\n<td>\n<p>Metronidazole</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which antiviral drug possesses dual antiviral activity against both HIV and HBV?", "options": [{"label": "A", "text": "Enfuvirtide", "correct": false}, {"label": "B", "text": "Abacavir", "correct": false}, {"label": "C", "text": "Tenofovir", "correct": true}, {"label": "D", "text": "Ritonavir", "correct": false}], "correct_answer": "C. Tenofovir", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Tenofov\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the term used to describe the likelihood of an infection occurring in a susceptible individual after coming into contact with an i nfectious person during the incubation period?", "options": [{"label": "A", "text": "Secondary attack rate", "correct": true}, {"label": "B", "text": "Case fatality rate", "correct": false}, {"label": "C", "text": "Primary attack rate", "correct": false}, {"label": "D", "text": "Tertiary attack rate", "correct": false}], "correct_answer": "A. Secondary attack rate", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Secondary attack\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the prescribed dosage of hydrocortisone for adrenal insufficiency, measured in milligrams per square meter per day?", "options": [{"label": "A", "text": "20", "correct": false}, {"label": "B", "text": "25", "correct": false}, {"label": "C", "text": "10", "correct": true}, {"label": "D", "text": "5", "correct": false}], "correct_answer": "C. 10", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the options below does not lead to water hardness?", "options": [{"label": "A", "text": "Calcium carbonate", "correct": true}, {"label": "B", "text": "Calcium sulphate", "correct": false}, {"label": "C", "text": "Calcium bicarbonate", "correct": false}, {"label": "D", "text": "Magnesium bicarbonate", "correct": false}], "correct_answer": "A. Calcium carbonate", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A: &lt;span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\"&gt;Calcium&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the drug of choice for scrub typhus ?", "options": [{"label": "A", "text": "Doxycycline", "correct": true}, {"label": "B", "text": "Azithromycin", "correct": false}, {"label": "C", "text": "Chloramphenicol", "correct": false}, {"label": "D", "text": "Ciprofloxacin", "correct": false}], "correct_answer": "A. Doxycycline", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - D\n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td>\n<p><strong>Older </strong></p>\n</td>\n<td>\n<p><strong>Newer</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Tetracycline, Oxytetracycline, Chlortetracycline, Demeclocycline</p>\n</td>\n<td>\n<p>Doxycycline, Minocycline, Tigecycline </p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Incomplete absorption </p>\n</td>\n<td>\n<p>Good oral absorption </p>\n</td>\n</tr>\n<tr>\n<td>\n<p>More chance of diarrhoea </p>\n</td>\n<td>\n<p>Less chance of diarrhoea</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Food interactions (milk, antacids)</p>\n</td>\n<td>\n<p>Less Food interactions</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following drugs is associated with QT prolongation ?", "options": [{"label": "A", "text": "Lignocaine", "correct": false}, {"label": "B", "text": "Quinidine", "correct": true}, {"label": "C", "text": "Magnesium sulfate", "correct": false}, {"label": "D", "text": "All of the above", "correct": false}], "correct_answer": "B. Quinidine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Qu\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Drug Class</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Examples</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Antiarrhythmics</strong></p>\n</td>\n<td>\n<p>Quinidine, Procainamide, Amiodarone, Sotalol</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Antibiotics</strong></p>\n</td>\n<td>\n<p>Erythromycin, Fluoroquinolones, Ciprofloxacin, Bedaquilline, Delamanid, Pretomanid</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Antidepressants</strong></p>\n</td>\n<td>\n<p>Amitriptyline, Desipramine, Doxepin, Fluoxetine, Sertraline, Venlafaxine</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Antipsychotics</strong></p>\n</td>\n<td>\n<p>Haloperidol, Thioridazine, Quetiapine</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Antiemetics</strong></p>\n</td>\n<td>\n<p>Dolasetron</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Opioids</strong></p>\n</td>\n<td>Methadone</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following options does not represent a method of direct transmission of communicable diseases ?", "options": [{"label": "A", "text": "Vertical transmission", "correct": false}, {"label": "B", "text": "Contact with soil", "correct": false}, {"label": "C", "text": "Droplet nuclei", "correct": true}, {"label": "D", "text": "Droplet transmission", "correct": false}], "correct_answer": "C. Droplet nuclei", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"33843a1c3716927771867f807275d2\"&gt;Droplet&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"e6b47028191692777193eb698e43b6\"&gt;nuclei&lt;/span&gt; (in bold letters)\n<table>\n<tbody>\n<tr>\n<td style=\"text-align:center\"><strong>Direct Transmission</strong></td>\n<td style=\"text-align:center\"><strong>Indirect Transmission</strong></td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Direct contact\n\t\t\t\t<ul>\n<li>E.g. Scabies, dermatitis</li>\n</ul>\n</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Vehicle borne\n\t\t\t\t<ul>\n<li>Blood borne - HIV, hepatitis</li>\n<li>Food borne - GI infections, <span class=\"customMeta\" data-dictid=\"f2f6f9068216927772016cacf26183\">typhoid</span> cholera.</li>\n<li>Water borne - GI infections, typhoid, cholera</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>Droplet infection</td>\n<td>\n<ul>\n<li>Droplet nuclei\n\t\t\t\t<ul>\n<li>Air borne</li>\n<li>Dust</li>\n<li>Diseases: Measles, chickenpox, TB, influenza, covid 19.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Contact with soil</li>\n<li>E.g. Tetanus</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Vector borne\n\t\t\t\t<ul>\n<li>Mechanical vector</li>\n<li>Biological <span class=\"customMeta\" data-dictid=\"1f7e7543bc16927772015cdb525c2b\">vector</span> - malaria</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Inoculation into skin or mucosa</li>\n<li>E.g. Dog bite, <span class=\"customMeta\" data-dictid=\"fa9d83d3d41692777189a8b393dd60\">HIV</span> by needle <span class=\"customMeta\" data-dictid=\"3cb00f13ee1692777196d9d02a760d\">prick</span> injury</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Fomite borne: <span class=\"customMeta\" data-dictid=\"9996ef505516927771937fe4ef1222\">Non</span> living thing or <span class=\"customMeta\" data-dictid=\"47755ae5261692777190f28393bfca\">inanimate</span> object.\n\t\t\t\t<ul>\n<li>Contaminated door handles, tables, chairs etc.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Vertical transmission\n\t\t\t\t<ul>\n<li>From mother to baby.</li>\n<li>E.g.\n\t\t\t\t\t<ul>\n<li>1<sup>st</sup> <span class=\"customMeta\" data-dictid=\"2c20f0f1dd169277720029d29458d5\">trimester</span> - Rubella, chickenpox.</li>\n<li>2<sup>nd</sup> <span class=\"customMeta\" data-dictid=\"2c20f0f1dd169277720029d29458d5\">trimester</span> - parvovirus</li>\n<li>3<sup>rd</sup> <span class=\"customMeta\" data-dictid=\"2c20f0f1dd169277720029d29458d5\">trimester</span> - Toxoplasmosis, <span class=\"customMeta\" data-dictid=\"ee831318721692777185479e65655e\">cytomegalovirus</span> infection, <span class=\"customMeta\" data-dictid=\"39867f177b16927771888cf43850d5\">hepatitis</span> B, syphilis.</li>\n<li>During delivery - HIV, Herpes.</li>\n</ul>\n</li>\n</ul>\n</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Unclean hands and fingers</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the mechanism of action of sacubitril, a newly approved drug for the treatment of chronic heart failure?", "options": [{"label": "A", "text": "Angiotensin II inhibitor", "correct": false}, {"label": "B", "text": "ACE inhibitor", "correct": false}, {"label": "C", "text": "Renin inhibitor", "correct": false}, {"label": "D", "text": "Neutral endopeptidase inhibitor", "correct": true}], "correct_answer": "D. Neutral endopeptidase inhibitor", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Neutral &lt;span class=\"customMeta\" data-dictid=\"448b58259f1692777187206caa1c8f\"&gt;endopeptidase&lt;/span&gt; inh\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What should be the minimum interval between the administration of two live vaccines ?", "options": [{"label": "A", "text": "2 weeks", "correct": false}, {"label": "B", "text": "4 weeks", "correct": true}, {"label": "C", "text": "8 weeks", "correct": false}, {"label": "D", "text": "12 weeks", "correct": false}], "correct_answer": "B. 4 weeks", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - 4 week\n<table border=\"1\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\"> </td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Live Vaccines</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Killed Vaccines</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Nature of the Vaccine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Contains a weakened or attenuated <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of the <span class=\"customMeta\" data-dictid=\"aa279cf1f016927771903f195bb1b9\">infectious</span> agent</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Contains inactivated or killed versions of the <span class=\"customMeta\" data-dictid=\"aa279cf1f016927771903f195bb1b9\">infectious</span> agent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Immune Response</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Stimulates a strong immune response, including both <span class=\"customMeta\" data-dictid=\"1a6d065f851692777189ba5533d1ef\">humoral</span> and <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> immunity</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Stimulates a relatively weaker <span class=\"customMeta\" data-dictid=\"dc6add5cf91692777189b30a6bae38\">immune response</span> primarily involving <span class=\"customMeta\" data-dictid=\"1a6d065f851692777189ba5533d1ef\">humoral</span> immunity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Duration of Protection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Usually provides long-lasting immunity</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>May require <span class=\"customMeta\" data-dictid=\"7725db2655169277718388f647e647\">booster</span> doses to maintain immunity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Vaccine Shedding</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>May shed the weakened <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of the <span class=\"customMeta\" data-dictid=\"aa279cf1f016927771903f195bb1b9\">infectious</span> agent, potentially causing mild illness in rare cases</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Does not shed the <span class=\"customMeta\" data-dictid=\"aa279cf1f016927771903f195bb1b9\">infectious</span> agent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Vaccine Efficacy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Generally higher <span class=\"customMeta\" data-dictid=\"7f80be61231692777187391e91e867\">efficacy</span> due to the <span class=\"customMeta\" data-dictid=\"3e05409f651692777197645882d8a2\">replication</span> of the weakened agent in the body</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Efficacy may be lower due to the absence of <span class=\"customMeta\" data-dictid=\"3e05409f651692777197645882d8a2\">replication</span> and <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> immune response</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Risk of Reversion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Small risk of <span class=\"customMeta\" data-dictid=\"2403264eee1692777197fd5c3caf46\">reversion</span> to a more <span class=\"customMeta\" data-dictid=\"417d56229b1692777202ce72999b28\">virulent</span> <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of the <span class=\"customMeta\" data-dictid=\"aa279cf1f016927771903f195bb1b9\">infectious</span> agent</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>No risk of <span class=\"customMeta\" data-dictid=\"2403264eee1692777197fd5c3caf46\">reversion</span> to a more <span class=\"customMeta\" data-dictid=\"417d56229b1692777202ce72999b28\">virulent</span> form</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Examples</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Measles, mumps, rubella, <span class=\"customMeta\" data-dictid=\"cf329b8cef169277720107b1efa15b\">varicella</span> (chickenpox), oral <span class=\"customMeta\" data-dictid=\"7b1b23cdec1692777196fb5ec9f3f5\">polio</span> vaccine, yellow fever, rotavirus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Influenza (injectable), <span class=\"customMeta\" data-dictid=\"7b1b23cdec1692777196fb5ec9f3f5\">polio</span> (inactivated), <span class=\"customMeta\" data-dictid=\"39867f177b16927771888cf43850d5\">hepatitis</span> A, <span class=\"customMeta\" data-dictid=\"e407b4ecb9169277719549831239bb\">pertussis</span> (acellular), pneumococcal <span class=\"customMeta\" data-dictid=\"2421c657771692777185af1b7b59c3\">conjugate</span> vaccine</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which drugs require monitoring of the coagulation profile during therapy?", "options": [{"label": "A", "text": "Fondaparinux", "correct": false}, {"label": "B", "text": "Enoxaparin", "correct": false}, {"label": "C", "text": "Dabigatran", "correct": false}, {"label": "D", "text": "Lepirudin", "correct": true}], "correct_answer": "D. Lepirudin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Lepiru\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Mononuclear Reed-Sternberg (RS) cells are seen in?", "options": [{"label": "A", "text": "Mixed cellular type HL", "correct": false}, {"label": "B", "text": "Nodular sclerosis HL", "correct": false}, {"label": "C", "text": "Lymphocyte-rich HL", "correct": true}, {"label": "D", "text": "Classical HL", "correct": false}], "correct_answer": "C. Lymphocyte-rich HL", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/0rS0B8yu7IEgWhQMrwdS1713172221.png", "https://image.prepladder.com/content/k0STMRxzzGnfBgyG2XMh1713172266.png"], "explanation": "<p>Correct Option C - Lymphocyte-rich HL\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td><strong>HL</strong></td>\n<td><strong>RS cell</strong></td>\n</tr>\n<tr>\n<td>Classical HL</td>\n<td><img src=\"https://image.prepladder.com/content/0rS0B8yu7IEgWhQMrwdS1713172221.png\" style=\"height:470px; width:500px\"/></td>\n</tr>\n<tr>\n<td>Nodular <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">sclerosis</span> HL</td>\n<td>\n<p>Lacunar cells</p>\n<p><img src=\"https://image.prepladder.com/content/k0STMRxzzGnfBgyG2XMh1713172266.png\" style=\"height:405px; width:500px\"/></p>\n</td>\n</tr>\n<tr>\n<td>Mixed <span class=\"customMeta\" data-dictid=\"aed7aaaa4516927771844cded86cdb\">cellularity</span> HL</td>\n<td>Classical RS cells (classical owl eye appearance)</td>\n</tr>\n<tr>\n<td>Lymphocyte-rich HL</td>\n<td>Mononuclear RS cells</td>\n</tr>\n<tr>\n<td>Lymphocyte-depleted HL</td>\n<td>Mummified RS cells</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following areas is not endemic to Kala-Azar ?", "options": [{"label": "A", "text": "West Bengal", "correct": false}, {"label": "B", "text": "UP", "correct": false}, {"label": "C", "text": "Bihar", "correct": false}, {"label": "D", "text": "Assam", "correct": true}], "correct_answer": "D. Assam", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Endemic Disease</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>States/Regions with High Prevalence</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Malaria</p>\n</td>\n<td>\n<p>Odisha, Chhattisgarh, Jharkhand, Assam, Tripura</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Dengue Fever</p>\n</td>\n<td>\n<p>Delhi, Maharashtra, Tamil Nadu, Kerala, West Bengal</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Chikungunya</p>\n</td>\n<td>\n<p>Kerala, Tamil Nadu, Maharashtra, Karnataka, Delhi</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Tuberculosis (TB)</p>\n</td>\n<td>\n<p>Bihar, Uttar Pradesh, Rajasthan, Maharashtra, Tamil Nadu</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Kala-Azar (Visceral Leishmaniasis)</p>\n</td>\n<td>\n<p>Bihar, West Bengal, Uttar Pradesh, Jharkhand</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Japanese Encephalitis</p>\n</td>\n<td>\n<p>Assam, Uttar Pradesh, Bihar, West Bengal, Tamil Nadu</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Typhoid Fever</p>\n</td>\n<td>\n<p>Punjab, Uttar Pradesh, Haryana, Bihar, Rajasthan</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Cholera</p>\n</td>\n<td>\n<p>West Bengal, Bihar, Odisha, Maharashtra, Uttar Pradesh</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Filariasis</p>\n</td>\n<td>\n<p>Uttar Pradesh, Bihar, West Bengal, Tamil Nadu</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Leprosy</p>\n</td>\n<td>\n<p>Uttar Pradesh, Maharashtra, Bihar, Chhattisgarh, Odisha</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the subsequent antihypertensive medications are contraindicated during pregnancy?", "options": [{"label": "A", "text": "Alpha methyldopa", "correct": false}, {"label": "B", "text": "Hydralazine", "correct": false}, {"label": "C", "text": "Propranolol", "correct": true}, {"label": "D", "text": "Labetalol", "correct": false}], "correct_answer": "C. Propranolol", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C: P\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Among the subsequent atypical antipsychotic medications, which one poses the greatest likelihood of galactorrhea?", "options": [{"label": "A", "text": "Iloperidone", "correct": false}, {"label": "B", "text": "Risperidone", "correct": true}, {"label": "C", "text": "Clozapine", "correct": false}, {"label": "D", "text": "Aripiprazole", "correct": false}], "correct_answer": "B. Risperidone", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - R\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In ecological studies, what is the unit of observation?", "options": [{"label": "A", "text": "Population", "correct": true}, {"label": "B", "text": "Patient", "correct": false}, {"label": "C", "text": "Healthy individuals", "correct": false}, {"label": "D", "text": "Case", "correct": false}], "correct_answer": "A. Population", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Popu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/qbh7rTh02dvrZQgJD1HT1746258905.mp3", "video": ""}, {"text": "When the pH = pKa of a drug, which of the following statements is true ?", "options": [{"label": "A", "text": "Concentration of the drug is 50% ionic and 50% non-ionic", "correct": true}, {"label": "B", "text": "Concentration of the drug is 90% ionic and 10% non-ionic", "correct": false}, {"label": "C", "text": "Concentration of the drug is 75% ionic and 25% non-ionic", "correct": false}, {"label": "D", "text": "Concentration of the drug is 25% ionic and 75% non-ionic", "correct": false}], "correct_answer": "A. Concentration of the drug is 50% ionic and 50% non-ionic", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Concentration of the drug is 50% ionic and 50%\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which corticosteroid is recommended for promoting the maturation of fetal lungs in preterm labor?", "options": [{"label": "A", "text": "Hydrocortisone", "correct": false}, {"label": "B", "text": "Triamcinolone", "correct": false}, {"label": "C", "text": "Methylprednisolone", "correct": false}, {"label": "D", "text": "Betamethasone", "correct": true}], "correct_answer": "D. Betamethasone", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D: Betameth\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In fungi, where does amphotericin B primarily exert its effects?", "options": [{"label": "A", "text": "Nucleic acid", "correct": false}, {"label": "B", "text": "Ribosome", "correct": false}, {"label": "C", "text": "Cell membrane", "correct": true}, {"label": "D", "text": "Cytoplasm", "correct": false}], "correct_answer": "C. Cell membrane", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following actions leads to a decrease in bone resorption and an increase in bone formation?", "options": [{"label": "A", "text": "Strontium ranelate", "correct": true}, {"label": "B", "text": "Ibandronate", "correct": false}, {"label": "C", "text": "Teriparatide", "correct": false}, {"label": "D", "text": "Calcitonin", "correct": false}], "correct_answer": "A. Strontium ranelate", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/wOGeHSpHJloX5JXDn7Uh1715144297.png"], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"4126a29d6d1692777199a6ca7d64d4\"&gt;Strontium&lt;/span&g\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Drug name</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Drugs used to increase the activity of osteoblasts</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Drugs used to decrease the activity of osteoclasts</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Teriparatide</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>✓</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>X</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Abaloparatide</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>✓</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>X</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Strontium ranelate (it is called as dual acting drug)</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>✓</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>✓</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Bisphosphonates (BPNs)</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>X</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>✓</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Denosumab</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>X</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>✓</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Calcitonin</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>X</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>✓</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Raloxifene</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>X</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>✓</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the medication utilized for the treatment of refractory and intractable rheumatic chorea?", "options": [{"label": "A", "text": "Probenecid", "correct": false}, {"label": "B", "text": "Diazepam", "correct": false}, {"label": "C", "text": "Haloperidol", "correct": false}, {"label": "D", "text": "Sodium valproate", "correct": true}], "correct_answer": "D. Sodium valproate", "question_images": [], "explanation_images": [], "explanation": "\n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Epileptics uses </strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Non - <span class=\"customMeta\" data-dictid=\"eb8fb619d916927771879a8048d513\">epileptic</span> uses </strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Drug of choice:</p>\n<ul>\n<li>GTCS</li>\n<li>Myoclonic and absence seizures</li>\n<li>Lennox Gastaut syndrome </li>\n<li>Dravet syndrome </li>\n<li>Juvenile Myoclonic Epilepsy</li>\n<li>Status Epilepticus (but not the choice of drug)</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Mania </li>\n<li>Bipolar disorder</li>\n<li>Rapid cyclers</li>\n<li>Migraine prophylaxis </li>\n<li>Tardive dyskinesia </li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In which of the following medical conditions can the X-ray finding be observed?", "options": [{"label": "A", "text": "Esophageal atresia", "correct": false}, {"label": "B", "text": "Esophageal stenosis", "correct": false}, {"label": "C", "text": "Reflux esophagitis", "correct": true}, {"label": "D", "text": "Barrett’s esophagus", "correct": false}], "correct_answer": "C. Reflux esophagitis", "question_images": ["https://image.prepladder.com/content/F2Dj9eejk0QHsILkEHmB1691455377.png"], "explanation_images": ["https://image.prepladder.com/content/HTscuoR6ZQw6uxKBtW3I1691455396.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is basiliximab?", "options": [{"label": "A", "text": "IL-1 receptor antagonist", "correct": false}, {"label": "B", "text": "Anit-CD3 antibody", "correct": false}, {"label": "C", "text": "IL-2 receptor antagonist", "correct": true}, {"label": "D", "text": "TNF inhibitor", "correct": false}], "correct_answer": "C. IL-2 receptor antagonist", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the structure marked in the CT scan shown below:", "options": [{"label": "A", "text": "Descending aorta", "correct": false}, {"label": "B", "text": "Ascending aorta", "correct": false}, {"label": "C", "text": "Superior vena cava", "correct": true}, {"label": "D", "text": "Right pulmonary artery", "correct": false}], "correct_answer": "C. Superior vena cava", "question_images": ["https://image.prepladder.com/content/EQ5ebQdaYhQ1tJTkbgth1691498865.png"], "explanation_images": ["https://image.prepladder.com/content/GoRu427ECadBS2LGyOiN1695368173.png", "https://image.prepladder.com/content/J0t2NOhWZSwuWOkevhwM1695368181.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following conditions can be treated with pirenzepine?", "options": [{"label": "A", "text": "Asthma", "correct": false}, {"label": "B", "text": "Peptic ulcer disease", "correct": true}, {"label": "C", "text": "Glaucoma", "correct": false}, {"label": "D", "text": "Hypertension", "correct": false}], "correct_answer": "B. Peptic ulcer disease", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"f6768ff15f1692777195a493cad3a9\"&gt;Peptic&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\"&gt;ulcer&lt;/span&g\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Drug Class</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Examples</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Mechanism of Action</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Proton Pump Inhibitors (PPIs)</p>\n</td>\n<td>\n<p>Omeprazole, Esomeprazole, Lansoprazole</p>\n</td>\n<td>\n<p>Inhibit the <span class=\"customMeta\" data-dictid=\"9c823198d61692777196bc71097d6d\">proton</span> pump (H<sup>+</sup>/K<sup>+</sup> ATPase) in <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> <span class=\"customMeta\" data-dictid=\"51df38de3d1692777194ced4c4bab5\">parietal</span> cells, reducing acid <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> and promoting <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> healing.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Histamine H2 <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">Receptor</span> Antagonists</p>\n</td>\n<td>\n<p>Ranitidine, Famotidine, Cimetidine</p>\n</td>\n<td>\n<p>Block the <span class=\"customMeta\" data-dictid=\"b5d4ddbfe71692777189a12acd5502\">histamine</span> H2 receptors on <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> <span class=\"customMeta\" data-dictid=\"51df38de3d1692777194ced4c4bab5\">parietal</span> cells, reducing acid <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> and promoting <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> healing.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Antacids</p>\n</td>\n<td>\n<p>Aluminum hydroxide, <span class=\"customMeta\" data-dictid=\"4d7ed0baae169277719199f6e9ab7b\">Magnesium</span> hydroxide</p>\n</td>\n<td>\n<p>Neutralize <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> acid, providing temporary relief from symptoms and promoting <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> healing.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Mucosal Protective Agents</p>\n</td>\n<td>\n<p>Sucralfate, Misoprostol</p>\n</td>\n<td>\n<p>Enhance mucosal defense mechanisms, promote mucosal healing, and reduce acid secretion.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Antibiotics</p>\n</td>\n<td>\n<p>Amoxicillin, Clarithromycin, Metronidazole</p>\n</td>\n<td>\n<p>Used in combination therapy to eradicate <span class=\"customMeta\" data-dictid=\"313a9372811692777188be2ca0dedc\">Helicobacter</span> pylori infection, which is associated with <span class=\"customMeta\" data-dictid=\"f6768ff15f1692777195a493cad3a9\">peptic</span> ulcers.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>M1 Blockers</p>\n</td>\n<td>\n<p>Pirenzepine, Telenzepine</p>\n</td>\n<td>\n<p>Selectively block <span class=\"customMeta\" data-dictid=\"0ad3c97c2916927771938768dcf298\">muscarinic</span> M1 receptors in the <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> <span class=\"customMeta\" data-dictid=\"51df38de3d1692777194ced4c4bab5\">parietal</span> cells, reducing acid <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> and promoting <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> healing.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following antimicrobials is effective against an organism producing extended-spectrum beta-lactamases ?", "options": [{"label": "A", "text": "Amoxicillin – Clavulanic acid", "correct": false}, {"label": "B", "text": "Penicillin", "correct": false}, {"label": "C", "text": "Piperacillin – Tazobactam", "correct": true}, {"label": "D", "text": "Ceftriaxone", "correct": false}], "correct_answer": "C. Piperacillin – Tazobactam", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Piperacillin – T\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the options hinders the production of glucocorticoid?", "options": [{"label": "A", "text": "Mifepristone", "correct": false}, {"label": "B", "text": "Flutamide", "correct": false}, {"label": "C", "text": "Finasteride", "correct": false}, {"label": "D", "text": "Metyrapone", "correct": true}], "correct_answer": "D. Metyrapone", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - M\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The X Ray of the skull as shown in the image given below is seen in:", "options": [{"label": "A", "text": "Hyperparathyroidism", "correct": true}, {"label": "B", "text": "Multiple myeloma", "correct": false}, {"label": "C", "text": "Hyperthyroidism", "correct": false}, {"label": "D", "text": "Paget’s disease", "correct": false}], "correct_answer": "A. Hyperparathyroidism", "question_images": ["https://image.prepladder.com/content/puQT9FlRULxoB7hYg2An1691498960.png"], "explanation_images": ["https://image.prepladder.com/content/CzFGOquMw1EqNgG9ewWJ1695368212.png"], "explanation": "<p>Correct Option A: Hyperparath\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Isosorbide dinitrate is indicated for congestive heart failure in combination with which of the following vasodilators ?", "options": [{"label": "A", "text": "Minoxidil", "correct": false}, {"label": "B", "text": "Hydralazine", "correct": true}, {"label": "C", "text": "Nimodipine", "correct": false}, {"label": "D", "text": "Nitrendipine", "correct": false}], "correct_answer": "B. Hydralazine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - H\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "How does colchicine work in the body?", "options": [{"label": "A", "text": "Inhibits synthesis of uric acid", "correct": false}, {"label": "B", "text": "Promotes excretion of uric acid", "correct": false}, {"label": "C", "text": "Inhibits xanthine oxidase enzyme", "correct": false}, {"label": "D", "text": "Binds to tubulin and inhibits granulocyte migration", "correct": true}], "correct_answer": "D. Binds to tubulin and inhibits granulocyte migration", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Colch\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which dye is employed for the identification of esophageal perforation during diagnosis?", "options": [{"label": "A", "text": "Gastrografin", "correct": false}, {"label": "B", "text": "Iohexol", "correct": true}, {"label": "C", "text": "Gadolinium", "correct": false}, {"label": "D", "text": "Barium sulfate", "correct": false}], "correct_answer": "B. Iohexol", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B: Ioh\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements accurately describes prasugrel?", "options": [{"label": "A", "text": "It acts as an P2Y12 agonist", "correct": false}, {"label": "B", "text": "It is 10 times less potent than clopidogrel", "correct": false}, {"label": "C", "text": "It is a pro drug", "correct": true}, {"label": "D", "text": "Omeprazole interferes in its activation to an active metabolite", "correct": false}], "correct_answer": "C. It is a pro drug", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - It is a pro drug\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Target</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Drug </strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Action </strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Use </strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"1\" rowspan=\"2\">\n<p><strong>GP IIb/IIa</strong></p>\n<p> </p>\n</td>\n<td>\n<p>Abicixmab (longer acting with short half time)</p>\n<ul>\n<li>\n<p>Safe in <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure with no dose reduction</p>\n</li>\n<li>\n<p>Adverse effects include <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> and thrombocytopenia</p>\n</li>\n</ul>\n</td>\n<td>\n<p>High – <span class=\"customMeta\" data-dictid=\"227269f3ec1692777180d76a7898dd\">affinity</span> <span class=\"customMeta\" data-dictid=\"f03ca2d2a716927771901227bc175a\">inhibition</span> of GP IIb/IIa and vitronectin</p>\n</td>\n<td>\n<ul>\n<li>\n<p>Acute <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> syndrome (ACS)</p>\n</li>\n<li>\n<p>Myocardial <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">infarction</span> and</p>\n</li>\n<li>\n<p>Percutaneous <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> intervention (PCI)</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>\n<p>Tirofiban</p>\n</li>\n<li>\n<p>Eptifibatide (injectable)</p>\n</li>\n</ul>\n</td>\n<td>\n<p> </p>\n</td>\n<td>\n<p>PCT and ACS</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"1\" rowspan=\"2\">\n<p><strong>P2Y12</strong></p>\n<p> </p>\n</td>\n<td>\n<p>Irreversible Antagonists:</p>\n<ul>\n<li>\n<p>Clopidogrel</p>\n</li>\n<li>\n<p>Prasugrel (faster)</p>\n</li>\n</ul>\n<p>Both are prodrugs:</p>\n<ul>\n<li>\n<p>Ticlopidine (adverse effect includes Diarrhoea)</p>\n</li>\n</ul>\n</td>\n<td>\n<p> </p>\n</td>\n<td>\n<ul>\n<li>\n<p>Myocardial <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">infarction</span> and stroke</p>\n</li>\n<li>\n<p>Myocardial <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">infarction</span> only (contraindicated in stroke)</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Reversible antagonists:</p>\n<ul>\n<li>\n<p>Cangrelor (I.V.)</p>\n</li>\n<li>\n<p>Ticagrelor</p>\n</li>\n</ul>\n</td>\n<td>\n<p> </p>\n</td>\n<td>\n<ul>\n<li>\n<p>PCI and ACS</p>\n</li>\n<li>\n<p>M.I. Prophylaxis</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>PAR</strong></p>\n</td>\n<td>\n<p>Vorapaxar and Atopaxar</p>\n</td>\n<td>\n<p> </p>\n</td>\n<td>\n<p>M.I. Prophylaxis</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>TxA2</strong></p>\n</td>\n<td>\n<p>TxA2 <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antagonists</p>\n<ul>\n<li>\n<p>Terutroban</p>\n</li>\n<li>\n<p>Low soe <span class=\"customMeta\" data-dictid=\"deba671f4716927771828c95a320e5\">aspirin</span> (40-325 mg)</p>\n</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>\n<p>Undertrial</p>\n</li>\n<li>\n<p>Inhibits <span class=\"customMeta\" data-dictid=\"cbe27145221692777185a3b125aa48\">cox</span> 1&amp; 2 <span class=\"customMeta\" data-dictid=\"ee77d507701692777190bfcf47b497\">irreversible</span> leading to decrease in TxA2</p>\n</li>\n</ul>\n</td>\n<td>\n<p>For M.I. (162-325mg)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Phosphodiesterase</strong></p>\n</td>\n<td>\n<p><strong>Inhibitors</strong>:</p>\n<ul>\n<li>\n<p>Cilastazole</p>\n</li>\n<li>\n<p>Dipyridamole</p>\n</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>\n<p>Increase in cAMP leading to the <span class=\"customMeta\" data-dictid=\"f03ca2d2a716927771901227bc175a\">inhibition</span> of <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">platelet</span> aggregation</p>\n</li>\n<li>\n<p>Increases <span class=\"customMeta\" data-dictid=\"d3f6a49b7416927771802124ccddf0\">adenosine</span> activity and decreases <span class=\"customMeta\" data-dictid=\"d3f6a49b7416927771802124ccddf0\">adenosine</span> uptake</p>\n</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>\n<p>Peripheral <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> disease</p>\n</li>\n<li>\n<p>Stroke Prophylaxis</p>\n</li>\n<li>\n<p>Cardiac stress testing</p>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old patient has come with sudden onset of chest pain and his CT scan shows the following picture. What is the diagnosis?", "options": [{"label": "A", "text": "Pulmonary embolism", "correct": false}, {"label": "B", "text": "Aortic dissection", "correct": true}, {"label": "C", "text": "Aortic aneurysm", "correct": false}, {"label": "D", "text": "Myocardial infarction", "correct": false}], "correct_answer": "B. Aortic dissection", "question_images": ["https://image.prepladder.com/content/1b3ve38cmROuRq6BXXHQ1691499062.png"], "explanation_images": [], "explanation": "<p>Correct Option B: A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "To which class of drugs does Apixaban belong in?", "options": [{"label": "A", "text": "Antifibrinolytic", "correct": false}, {"label": "B", "text": "Factor Xa inhibitors", "correct": true}, {"label": "C", "text": "Oral direct thrombin inhibitor", "correct": false}, {"label": "D", "text": "Parenteral direct thrombin inhibitor", "correct": false}], "correct_answer": "B. Factor Xa inhibitors", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Factor Xa inh\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable diagnosis for a young woman taking oral contraceptives based on the provided scan?", "options": [{"label": "A", "text": "Hepatocellular carcinoma", "correct": false}, {"label": "B", "text": "Metastatic infiltrates", "correct": false}, {"label": "C", "text": "Hepatic adenoma", "correct": true}, {"label": "D", "text": "Hemangioma", "correct": false}], "correct_answer": "C. Hepatic adenoma", "question_images": ["https://image.prepladder.com/content/016GmOXFYS5HSUIKtqtj1695368367.png"], "explanation_images": ["https://image.prepladder.com/content/1x4T9SHTwtD4g2eHvbnJ1695368387.png", "https://image.prepladder.com/content/xNoartXFdpUe5MgXPj4g1695368382.png"], "explanation": "<p>Correct Option C: H\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Lesion</strong></p>\n</td>\n<td>\n<p><strong>Characteristic Findings on Radiological <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">Diagnostic</span> Modalities</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Hepatic cyst</p>\n</td>\n<td>\n<p>Sharply demarcated wall, water density, non- enhancing</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Hemangioma</p>\n</td>\n<td>\n<p>Peripheral <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> in of contrast over time \"Light Bulb Sign\" on T2 <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> (centripetal filling)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Focal <span class=\"customMeta\" data-dictid=\"bfa856c77716927771939978c5afd0\">nodular</span> <span class=\"customMeta\" data-dictid=\"4c5d5ef6c31692777189820d4b320d\">hyperplasia</span> (FNH)</p>\n</td>\n<td>\n<p>Early <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> in the arterial phase with central <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> (scar) <span class=\"customMeta\" data-dictid=\"4da708f8ee169277720241f79d3c3a\">fibrolamellar</span> HCC.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Hepatic adenoma</p>\n</td>\n<td>\n<p>Variable, central changes due to <span class=\"customMeta\" data-dictid=\"4642acfc0c16927771880b34fa5174\">hemorrhage</span> are often seen</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Metastasis</p>\n</td>\n<td>\n<p>Mostly multiple low <span class=\"customMeta\" data-dictid=\"22818451b71692777182237914a233\">attenuation</span> lesions, rim <span class=\"customMeta\" data-dictid=\"4749be0e3f1692777187a4b4100c1d\">enhancement</span> without \"filling in\" (bull eye appearance on ultrasound)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Abscess</p>\n</td>\n<td>\n<p>Well-demarcated <span class=\"customMeta\" data-dictid=\"11309a56bc1692777189e89a8d3041\">hypodense</span> areas with <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> enhancement</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Hepatocellular <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> (HCC)</p>\n</td>\n<td>\n<p>Early arterial enhancement, fast washout, delayed <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> <span class=\"customMeta\" data-dictid=\"54635b1bf01692777183247ecff5e0\">capsule</span> enhancement</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the consequence of thrombosis in the posterior inferior cerebellar artery?", "options": [{"label": "A", "text": "Lateral medullary syndrome", "correct": true}, {"label": "B", "text": "Weber syndrome", "correct": false}, {"label": "C", "text": "Medial medullary syndrome", "correct": false}, {"label": "D", "text": "Millard Gubler syndrome", "correct": false}], "correct_answer": "A. Lateral medullary syndrome", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\"&gt;Lateral&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"0a36e18386169277719259641cf29b\"&gt;medullary&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a patient who has symptoms of frequent urination, nocturia, and enuresis, along with a 24-hour urine volume of 7 liters, a urine osmolarity of 260 mOsm/L, an ADH assay result of 0.8 pg/ml, and a brain MRI showing no bright spot on T1 weighted images?", "options": [{"label": "A", "text": "Nephrogenic DI", "correct": false}, {"label": "B", "text": "Primary polydipsia", "correct": false}, {"label": "C", "text": "Pituitary DI", "correct": true}, {"label": "D", "text": "Mannitol infusion", "correct": false}], "correct_answer": "C. Pituitary DI", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\"&gt;Pituitary&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"7194dbeaed1692777186e2554f8ebf\"&gt;DI&lt;/span&gt; (diabetes insipidus)\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child presents with left to right shunt and high output cardiac failure . The following is his MRA . What is the diagnosis?", "options": [{"label": "A", "text": "Vein of Galen malformation", "correct": true}, {"label": "B", "text": "Dandy Walker syndrome", "correct": false}, {"label": "C", "text": "Pneumocephalus", "correct": false}, {"label": "D", "text": "Venous sinus thrombosis", "correct": false}], "correct_answer": "A. Vein of Galen malformation", "question_images": ["https://image.prepladder.com/content/GfBADyVFw1Q8ommnl5RK1691499119.png"], "explanation_images": [], "explanation": "<p>Correct Option A: Vein of G\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The most consistent and persistent feature of bladder carcinoma is:", "options": [{"label": "A", "text": "Painless hematuria", "correct": true}, {"label": "B", "text": "Painful hematuria", "correct": false}, {"label": "C", "text": "Dysuria", "correct": false}, {"label": "D", "text": "Suprapubic mass", "correct": false}], "correct_answer": "A. Painless hematuria", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Painless hematu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the diagnosis based on the given image?", "options": [{"label": "A", "text": "Uterus didelphys", "correct": false}, {"label": "B", "text": "Bicornuate uterus", "correct": false}, {"label": "C", "text": "Unicornuate uterus", "correct": true}, {"label": "D", "text": "Septate uterus", "correct": false}], "correct_answer": "C. Unicornuate uterus", "question_images": ["https://image.prepladder.com/content/5RFfvZ4oldhFCHSBlxUk1691499188.png"], "explanation_images": ["https://image.prepladder.com/content/74h6CMabpSncObTNKgk71695368496.png", "https://image.prepladder.com/content/Yp2J2ZcEtvHhyiQMo1QQ1695368469.png", "https://image.prepladder.com/content/mM6KjVvz7ak7crNygLef1695368463.png", "https://image.prepladder.com/content/VsrzcUqSKogodqWQOT6s1695368476.png", "https://image.prepladder.com/content/BhXG3eETyIaAfetp7bjE1695368481.png"], "explanation": "<p>Correct Option C: Unicornuate uteru\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In which situation is the Bragg peak effect most prominent?", "options": [{"label": "A", "text": "Xray", "correct": false}, {"label": "B", "text": "Proton", "correct": true}, {"label": "C", "text": "Neutron", "correct": false}, {"label": "D", "text": "Electron", "correct": false}], "correct_answer": "B. Proton", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/j3izBH9gXEEV4HF6HRLb1695368550.png", "https://image.prepladder.com/content/FPSHw96rROwEziEpU10J1695368543.png"], "explanation": "<p>Correct Option B: P\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The image seen below shows", "options": [{"label": "A", "text": "Magnetic Resonance Imaging", "correct": false}, {"label": "B", "text": "Positron Emission Tomogrpahy", "correct": false}, {"label": "C", "text": "Hysterosalpingography", "correct": true}, {"label": "D", "text": "Laparoscopic chromopertubation", "correct": false}], "correct_answer": "C. Hysterosalpingography", "question_images": ["https://image.prepladder.com/content/NUcnPqI5NdP6akWmW4cT1691499261.png"], "explanation_images": ["https://image.prepladder.com/content/hImrvfYQdBl83MIgH98r1695368585.png"], "explanation": "<p>Correct Option C: Hysterosalpingograph\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Fever occurs during inflammation due to all except :", "options": [{"label": "A", "text": "IL-1", "correct": false}, {"label": "B", "text": "Prostaglandins", "correct": false}, {"label": "C", "text": "TNF", "correct": false}, {"label": "D", "text": "Histamine", "correct": true}], "correct_answer": "D. Histamine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - H\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td><strong>Fever</strong></td>\n<td>\n<ul>\n<li>IL-1</li>\n<li>IL-6</li>\n<li>TNF-α</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td><strong>T-cell maturation</strong></td>\n<td>IL-7</td>\n</tr>\n<tr>\n<td><strong>Eosinophils activation</strong></td>\n<td>IL-5</td>\n</tr>\n<tr>\n<td><strong>Neutrophil recruitment</strong></td>\n<td>IL-8</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/WiXjt7ApJEnSA92vVYtH1747055698.mp3", "video": ""}, {"text": "Which prolactin levels are indicative of prolactinoma?", "options": [{"label": "A", "text": "&amp;gt;50µg/L", "correct": false}, {"label": "B", "text": "&amp;gt;100µg/L", "correct": false}, {"label": "C", "text": "&amp;gt;150µg/L", "correct": false}, {"label": "D", "text": "&amp;gt;200µg/L", "correct": true}], "correct_answer": "D. &gt;200µg/L", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Anaplasia refers to:", "options": [{"label": "A", "text": "Lack of differentiation", "correct": true}, {"label": "B", "text": "Variation in cell size and shape", "correct": false}, {"label": "C", "text": "Replacement of one type of cell by other", "correct": false}, {"label": "D", "text": "Disordered arrangement of tumor cells", "correct": false}], "correct_answer": "A. Lack of differentiation", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Lack\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td><strong>Anaplasia</strong></td>\n<td>Anaplasia is characterized by the loss of normal <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> differentiation</td>\n</tr>\n<tr>\n<td><strong>Metaplasia</strong></td>\n<td>Metaplasia refers to the <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">reversible</span> change of one <span class=\"customMeta\" data-dictid=\"0472620c171692777192c655af9c57\">mature</span> cell type to another <span class=\"customMeta\" data-dictid=\"0472620c171692777192c655af9c57\">mature</span> cell type in response to certain <span class=\"customMeta\" data-dictid=\"7d7e9fdf401692777199f2038941b6\">stimuli</span> or chronic irritation.</td>\n</tr>\n<tr>\n<td><strong>Pleomorphism</strong></td>\n<td>Pleomorphism refers to the presence of cells with different sizes and shapes within a tumor.</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/6Egj57Slpd0PGvQSBoID1749368609.mp3", "video": ""}, {"text": "Identify the artery marked by arrow", "options": [{"label": "A", "text": "Superior mesenteric artery", "correct": true}, {"label": "B", "text": "Inferior mesenteric", "correct": false}, {"label": "C", "text": "Celiac artery", "correct": false}, {"label": "D", "text": "Intestinal artery", "correct": false}], "correct_answer": "A. Superior mesenteric artery", "question_images": ["https://image.prepladder.com/content/iKTr4ewfrSaQwm3EIYMw1691499323.png"], "explanation_images": [], "explanation": "<table>\n<thead>\n<tr>\n<th>Artery</th>\n<th>Level on CT (Vertebral Level)</th>\n<th>Origin</th>\n<th>Branches</th>\n<th>Structures Supplied</th>\n<th>Imaging Clues on CT</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>Celiac Trunk</td>\n<td>T12–L1 (mainly T12)</td>\n<td>Abdominal <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> (anterior)</td>\n<td>Left gastric, splenic, common hepatic</td>\n<td>Foregut: <span class=\"customMeta\" data-dictid=\"6a729a105a169277718788389dbeab\">esophagus</span> to 2nd part of duodenum, etc.</td>\n<td>Short trunk, “tripod”/“trifurcation” appearance</td>\n</tr>\n<tr>\n<td>Superior Mesenteric</td>\n<td>L1</td>\n<td>Aorta (just below celiac)</td>\n<td>Inferior pancreaticoduodenal, jejunal, etc.</td>\n<td>Midgut: <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"280e59e9331692777186f3beac2c41\">duodenum</span> to <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> 2/3 transverse</td>\n<td>Long, <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> vessel <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> to celiac, over <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> vein</td>\n</tr>\n<tr>\n<td>Inferior Mesenteric</td>\n<td>L3</td>\n<td>Aorta (anterior)</td>\n<td>Left colic, sigmoid, superior rectal</td>\n<td>Hindgut: <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> 1/3 <span class=\"customMeta\" data-dictid=\"a6260fa86416927772008d36bd7e5f\">transverse</span> <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> to upper rectum</td>\n<td>Small, anterior, near aortic bifurcation</td>\n</tr>\n<tr>\n<td>Renal Arteries</td>\n<td>L1–L2</td>\n<td>Lateral aspect of aorta</td>\n<td>Segmental arteries</td>\n<td>Kidneys, <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> glands, ureters</td>\n<td>Course laterally; right passes <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> to IVC</td>\n</tr>\n<tr>\n<td>Gonadal Arteries</td>\n<td>L2</td>\n<td>Aorta (anterior/lateral)</td>\n<td>No major named branches</td>\n<td>Gonads (testes/ovaries)</td>\n<td>Thin, descending; rarely visible unless dilated</td>\n</tr>\n<tr>\n<td>Common <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">Iliac</span> Arteries</td>\n<td>L4</td>\n<td>Aortic bifurcation</td>\n<td>Internal and external <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> arteries</td>\n<td>Pelvis, lower limbs</td>\n<td> </td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is an opsonin?", "options": [{"label": "A", "text": "C3a", "correct": false}, {"label": "B", "text": "C3b", "correct": true}, {"label": "C", "text": "C5a", "correct": false}, {"label": "D", "text": "C6", "correct": false}], "correct_answer": "B. C3b", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - C3\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/zAtDd0cSZNpQ2L81LcHW1747055840.mp3", "video": ""}, {"text": "Which organism is most likely responsible for the development of prosthetic valve endocarditis in a patient following valve replacement surgery?", "options": [{"label": "A", "text": "Staphylococcus epidermidis", "correct": true}, {"label": "B", "text": "Staphylococcus aureus", "correct": false}, {"label": "C", "text": "Coagulase negative staphylococci", "correct": false}, {"label": "D", "text": "HACEK organisms", "correct": false}], "correct_answer": "A. Staphylococcus epidermidis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"71c203268816927771994a1fffd645\"&gt;Staphylococcus&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "CD-59 is involved in:", "options": [{"label": "A", "text": "Paroxysmal nocturnal hemoglobinuria", "correct": true}, {"label": "B", "text": "Chediak-Higashi syndrome", "correct": false}, {"label": "C", "text": "Essential thrombocythemia", "correct": false}, {"label": "D", "text": "Primary myelofibrosis", "correct": false}], "correct_answer": "A. Paroxysmal nocturnal hemoglobinuria", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"cd15fe58221692777194fbb9eec8d1\"&gt;Paroxysmal&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"d51601f2c41692777193ddfa55d163\"&gt;Nocturnal&lt;/span&gt; Hemoglobinu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What extra-articular manifestation is commonly observed in patients with rheumatoid arthritis?", "options": [{"label": "A", "text": "Subcutaneous nodule", "correct": true}, {"label": "B", "text": "Sjogren’s syndrome", "correct": false}, {"label": "C", "text": "Felty’s syndrome", "correct": false}, {"label": "D", "text": "Vasculitis", "correct": false}], "correct_answer": "A. Subcutaneous nodule", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\"&gt;Subcutaneous&lt;/span&gt; nodu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In which condition are macrophages observed to be positive for periodic acid Schiff staining?", "options": [{"label": "A", "text": "Agammaglobulinemia", "correct": false}, {"label": "B", "text": "Whipple’s disease", "correct": true}, {"label": "C", "text": "Abetalipoproteinemia", "correct": false}, {"label": "D", "text": "Crohn’s disease", "correct": false}], "correct_answer": "B. Whipple’s disease", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Wh\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Leiden mutation is of factor:", "options": [{"label": "A", "text": "V", "correct": true}, {"label": "B", "text": "VIII", "correct": false}, {"label": "C", "text": "I", "correct": false}, {"label": "D", "text": "X", "correct": false}], "correct_answer": "A. V", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A: V\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Condition</strong></p>\n</td>\n<td>\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Factor V Leiden mutation</strong></p>\n</td>\n<td>\n<p>Genetic <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> in <span class=\"customMeta\" data-dictid=\"14693f062c16927772024df5839c43\">factor V</span> that increases risk of <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> blood clotting</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Prothrombin gene mutation</strong></p>\n</td>\n<td>\n<p>Genetic <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> in the <span class=\"customMeta\" data-dictid=\"94b02f097916927771962072dbeeac\">prothrombin</span> gene leading to increased <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> activity</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Antithrombin deficiency</strong></p>\n</td>\n<td>\n<p>Deficiency in antithrombin, a protein that inhibits blood clotting</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Protein C deficiency</strong></p>\n</td>\n<td>\n<p>Deficiency in protein C, a natural anticoagulant</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Protein S deficiency</strong></p>\n</td>\n<td>\n<p>Deficiency in protein S, which acts as a <span class=\"customMeta\" data-dictid=\"a416d7580c1692777184952da793d1\">cofactor</span> for protein C</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Elevated <span class=\"customMeta\" data-dictid=\"65dc2273b5169277720208ba704b7f\">factor VIII</span> levels</strong></p>\n</td>\n<td>\n<p>Increased levels of factor VIII, a <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> protein</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Condition</strong></p>\n</td>\n<td>\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Pregnancy</strong></p>\n</td>\n<td>\n<p>Increased risk of <span class=\"customMeta\" data-dictid=\"40d68b98721692777183c42090e023\">blood clot</span> formation during pregnancy</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Oral <span class=\"customMeta\" data-dictid=\"a13cdc2a8a1692777185da87f2ff85\">contraceptive</span> use</strong></p>\n</td>\n<td>\n<p>Use of hormonal contraceptives can increase the risk of blood clots</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Estrogen therapy</strong></p>\n</td>\n<td>\n<p>Administration of estrogen-containing medications</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Obesity</strong></p>\n</td>\n<td>\n<p>Obesity is associated with an increased risk of blood clots</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Immobility</strong></p>\n</td>\n<td>\n<p>Prolonged periods of <span class=\"customMeta\" data-dictid=\"d9d99d2177169277718940abaf77fb\">immobility</span> can lead to <span class=\"customMeta\" data-dictid=\"40d68b98721692777183c42090e023\">blood clot</span> formation</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Surgery</strong></p>\n</td>\n<td>\n<p>Surgical procedures can trigger a hypercoagulable state</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Cancer</strong></p>\n</td>\n<td>\n<p>Certain cancers and cancer treatments increase the risk of blood clots</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Antiphospholipid syndrome</strong></p>\n</td>\n<td>\n<p>Autoimmune disorder that causes <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> clotting</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Nephrotic syndrome</strong></p>\n</td>\n<td>\n<p>Kidney disorder characterized by protein loss in urine</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis based on the image of the scan given below?", "options": [{"label": "A", "text": "Pituitary apoplexy", "correct": false}, {"label": "B", "text": "Pituitary macroadenoma", "correct": false}, {"label": "C", "text": "Rathke cleft cyst", "correct": false}, {"label": "D", "text": "Craniopharyngioma", "correct": true}], "correct_answer": "D. Craniopharyngioma", "question_images": ["https://image.prepladder.com/content/eZJk4y8CnFQte5ruRiCh1697525313.png"], "explanation_images": ["https://image.prepladder.com/content/EWIUYWCu8ZeJgcqkq4dY1695368640.png", "https://image.prepladder.com/content/5ltXq03hD07n1ApPpHLp1695368645.png"], "explanation": "<p>Correct Option D: Craniopharyng\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "According to the Berlin definition, which of the following is not a characteristic of moderate ARDS?", "options": [{"label": "A", "text": "200 &amp;lt; PaO2/FiO2 =&amp;lt;300mm/Hg with PEEP Is moderate", "correct": true}, {"label": "B", "text": "Bilateral interstitial infiltrates", "correct": false}, {"label": "C", "text": "Symptom onset within a week", "correct": false}, {"label": "D", "text": "No cardiac failure in echocardiography", "correct": false}], "correct_answer": "A. 200 &lt; PaO2/FiO2 =&lt;300mm/Hg with PEEP Is moderate", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - 200 &amp;lt; PaO&lt;sub&gt;2&lt;/sub&gt;/FiO&lt;sub&gt;2&lt;/sub&gt; =&amp;lt;300mm/Hg with &lt;span class=\"customMeta\" data-dictid=\"9abcb9edc11692777195dac40cd470\"&gt;PEEP&lt;/span&gt; I\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following diseases is associated with ATP7A gene causing low levels of copper in the blood stream?", "options": [{"label": "A", "text": "Dubin-Johnson syndrome", "correct": false}, {"label": "B", "text": "Wilson’s disease", "correct": false}, {"label": "C", "text": "Menke’s disease", "correct": true}, {"label": "D", "text": "Gilbert’s syndrome", "correct": false}], "correct_answer": "C. Menke’s disease", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C: Menk\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most important determinant of malignant potential in the papillary type of renal tumor ?", "options": [{"label": "A", "text": "Immunohistology", "correct": false}, {"label": "B", "text": "Size", "correct": true}, {"label": "C", "text": "Cytogenetics", "correct": false}, {"label": "D", "text": "Part of kidney involved", "correct": false}], "correct_answer": "B. Size", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - S\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the next recommended investigation to aid in diagnosing the condition of a patient who has cutaneous vasculitis, glomerulonephritis, and peripheral neuropathy?", "options": [{"label": "A", "text": "ANCA", "correct": true}, {"label": "B", "text": "RA factor", "correct": false}, {"label": "C", "text": "HbsAg", "correct": false}, {"label": "D", "text": "MIF", "correct": false}], "correct_answer": "A. ANCA", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - ANCA\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable cause of hypokalemia, hypertension, and metabolic alkalosis in a 35-year-old female patient?", "options": [{"label": "A", "text": "Bartter syndrome", "correct": false}, {"label": "B", "text": "Gitelman’s syndrome", "correct": false}, {"label": "C", "text": "Liddle’s syndrome", "correct": true}, {"label": "D", "text": "Fanconi’s syndrome", "correct": false}], "correct_answer": "C. Liddle’s syndrome", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Liddle’\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the approximate time interval between HIV infection &amp;amp; manifestation of AIDS in an untreated patient?", "options": [{"label": "A", "text": "7.5-years", "correct": false}, {"label": "B", "text": "10 years", "correct": true}, {"label": "C", "text": "12 years", "correct": false}, {"label": "D", "text": "5 years", "correct": false}], "correct_answer": "B. 10 years", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which diagnostic test is preferred for detecting HIV in a newborn delivered by an HIV-positive mother?", "options": [{"label": "A", "text": "HIV DNA PCR", "correct": true}, {"label": "B", "text": "Cord blood ELISA", "correct": false}, {"label": "C", "text": "Western blot", "correct": false}, {"label": "D", "text": "Third generation ELISA", "correct": false}], "correct_answer": "A. HIV DNA PCR", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"fa9d83d3d41692777189a8b393dd60\"&gt;HIV&lt;/span&gt; DNA PCR\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 33-year-old female came complains of weakness, easy fatigability, double vision and drooping of the upper eyelids. On examination her deep tendon reflexes are normal. What is the pathogenesis of the condition in this case?", "options": [{"label": "A", "text": "Decreased acetylcholine release at the nerve endings", "correct": false}, {"label": "B", "text": "Decreased myosin", "correct": false}, {"label": "C", "text": "Absence of troponin C", "correct": false}, {"label": "D", "text": "Decreased synaptic transmission at the myoneural junction", "correct": true}], "correct_answer": "D. Decreased synaptic transmission at the myoneural junction", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Decreased &lt;span class=\"customMeta\" data-dictid=\"5c4592475a1692777199991c761d11\"&gt;synaptic&lt;/span&gt; transmission at the &lt;span class=\"customMeta\" data-dictid=\"6e00e3eee21692777193dfa090411e\"&gt;myoneural&lt;/span&gt; ju\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements about Weber's syndrome is incorrect?", "options": [{"label": "A", "text": "Contralateral hemiplegia", "correct": false}, {"label": "B", "text": "Ipsilateral oculomotor nerve palsy", "correct": false}, {"label": "C", "text": "Contralateral parkinsonism", "correct": false}, {"label": "D", "text": "Ipsilateral paralysis of lower face", "correct": true}], "correct_answer": "D. Ipsilateral paralysis of lower face", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Ipsilateral &lt;span class=\"customMeta\" data-dictid=\"72fa9105b916927771945aef35e8ed\"&gt;paralysis&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the subsequent options is not typically observed in allergic bronchopulmonary aspergillosis?", "options": [{"label": "A", "text": "Low serum IgE levels", "correct": true}, {"label": "B", "text": "Cough", "correct": false}, {"label": "C", "text": "Wheezing", "correct": false}, {"label": "D", "text": "Central bronchiectasis", "correct": false}], "correct_answer": "A. Low serum IgE levels", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Low &lt;span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\"&gt;serum&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"a54166a5961692777189c5557f61f3\"&gt;IgE&lt;/span&gt; lev\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable condition of a 10-year-old boy complaining of recurrent episodes of intense pain in his fingers and toes that spontaneously resolve over the course of the last year?", "options": [{"label": "A", "text": "Alpha-thalassemia", "correct": false}, {"label": "B", "text": "Beta-thalassemia", "correct": false}, {"label": "C", "text": "Sickle cell anemia", "correct": true}, {"label": "D", "text": "Von Willebrand disease type 1", "correct": false}], "correct_answer": "C. Sickle cell anemia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Sick\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is grade 2 hypertension values according to the American Heart Association?", "options": [{"label": "A", "text": "&amp;gt;130/80 mmHg", "correct": false}, {"label": "B", "text": "≥140/90 mmHg", "correct": true}, {"label": "C", "text": "&amp;gt;150/96 mmHg", "correct": false}, {"label": "D", "text": "≥160/100 mmHg", "correct": false}], "correct_answer": "B. ≥140/90 mmHg", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/K34rSJS6n732xGL0sZLz1725874679.png"], "explanation": "<p>Correct Option D\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Cryoglobulinemia is associated with:", "options": [{"label": "A", "text": "Hepatitis C", "correct": true}, {"label": "B", "text": "Ovarian cancer", "correct": false}, {"label": "C", "text": "Diabetes", "correct": false}, {"label": "D", "text": "Leukaemia", "correct": false}], "correct_answer": "A. Hepatitis C", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"39867f177b16927771888cf43850d5\"&gt;Hepatitis&lt;/span&gt; C: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In which of the subsequent situations does oxygen therapy prove to be ineffective?", "options": [{"label": "A", "text": "Asthma", "correct": false}, {"label": "B", "text": "Acute myocardial infarction", "correct": false}, {"label": "C", "text": "Pulmonary edema", "correct": false}, {"label": "D", "text": "Central respiratory depression", "correct": true}], "correct_answer": "D. Central respiratory depression", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D: Central &lt;span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\"&gt;respiratory&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the typical pattern observed in Brown-Sequard syndrome?", "options": [{"label": "A", "text": "Contralateral loss of joint sense and position", "correct": false}, {"label": "B", "text": "Contralateral loss of pain sensation", "correct": true}, {"label": "C", "text": "Ipsilateral loss of complete sensory functions", "correct": false}, {"label": "D", "text": "Contralateral motor functions", "correct": false}], "correct_answer": "B. Contralateral loss of pain sensation", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - C\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements accurately describes the thyroid function test results for a middle-aged woman diagnosed with Grave's disease, presenting symptoms such as tremors, palpitations, weight loss, and menstrual irregularities?", "options": [{"label": "A", "text": "Low TSH levels", "correct": true}, {"label": "B", "text": "Low free T4 levels", "correct": false}, {"label": "C", "text": "Low serum T3 levels", "correct": false}, {"label": "D", "text": "Radioactive iodine uptake (RAIU) at 24 hours below normal", "correct": false}], "correct_answer": "A. Low TSH levels", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A: Low &lt;span class=\"customMeta\" data-dictid=\"e33d6cd73e1692777200667a6d2703\"&gt;TSH&lt;/span&gt; lev\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The observed myocardial stunning pattern does not match the patient's ECG findings . What is the probable diagnosis?", "options": [{"label": "A", "text": "Takotsubo cardiomyopathy", "correct": true}, {"label": "B", "text": "Restrictive cardiomyopathy", "correct": false}, {"label": "C", "text": "Brugada syndrome", "correct": false}, {"label": "D", "text": "Pericardial tamponade", "correct": false}], "correct_answer": "A. Takotsubo cardiomyopathy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Takotsubo cardiomyopath\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child presents with hepatitis and progressive neurological degeneration. A picture of his eye has been provided below . Among the following options, what would be the initial step regarding the investigations done for this child’s diagnosis?", "options": [{"label": "A", "text": "Serum ceruloplasmin levels", "correct": true}, {"label": "B", "text": "Serum copper levels", "correct": false}, {"label": "C", "text": "Enzyme assay", "correct": false}, {"label": "D", "text": "Karyotyping", "correct": false}], "correct_answer": "A. Serum ceruloplasmin levels", "question_images": ["https://image.prepladder.com/content/iqcR61gdyK7i48dI5uk71691499730.png"], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\"&gt;Serum&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"d0297935661692777184085cf7e86f\"&gt;ceruloplasmin&lt;/span&gt; lev\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which antiretroviral drug is not utilized in cases of concurrent HIV and hepatitis B infection?", "options": [{"label": "A", "text": "Tenofovir", "correct": false}, {"label": "B", "text": "Abacavir", "correct": true}, {"label": "C", "text": "Lamivudine", "correct": false}, {"label": "D", "text": "Emtricitabine", "correct": false}], "correct_answer": "B. Abacavir", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Abacav\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "‘c’ wave in JVP is seen in?", "options": [{"label": "A", "text": "Iso-volumetric contraction", "correct": true}, {"label": "B", "text": "Slow filling at end of diastole", "correct": false}, {"label": "C", "text": "End of systole", "correct": false}, {"label": "D", "text": "Start of diastole", "correct": false}], "correct_answer": "A. Iso-volumetric contraction", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Iso-volu\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>JVP Wave</strong></p>\n</td>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\">\n<p><strong>Event</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>'a' wave</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Atrial contraction</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>'c' wave</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Iso-volumetric <span class=\"customMeta\" data-dictid=\"ca2289e348169277718516017eb2ba\">contraction</span> of the ventricles</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>'v' wave</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Passive <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> of blood into the atria</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>'x' descent</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Atrial relaxation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>'y' descent</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rapid <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> filling</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "For which of the following conditions is automatic implantable cardioverter-defibrillator (AICD) implantation performed?", "options": [{"label": "A", "text": "Brugada syndrome", "correct": false}, {"label": "B", "text": "Ventricular fibrillation", "correct": false}, {"label": "C", "text": "Acute coronary syndrome with low ejection fraction", "correct": false}, {"label": "D", "text": "All the above", "correct": true}], "correct_answer": "D. All the above", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - All the abov\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All of the following are true regarding the actions of endothelin-1 except_________.", "options": [{"label": "A", "text": "Bronchodilation", "correct": true}, {"label": "B", "text": "Vasoconstriction", "correct": false}, {"label": "C", "text": "Decreased GFR", "correct": false}, {"label": "D", "text": "Has inotropic effect", "correct": false}], "correct_answer": "A. Bronchodilation", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In which electrolyte abnormality is Pseudo P pulmonale observed?", "options": [{"label": "A", "text": "Hypokalaemia", "correct": true}, {"label": "B", "text": "Hyponatremia", "correct": false}, {"label": "C", "text": "Hypocalcaemia", "correct": false}, {"label": "D", "text": "Hypercalcemia", "correct": false}], "correct_answer": "A. Hypokalaemia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/WsqzZs8kiIKL5F7YrjRz1694681794.png"], "explanation": "<p>Correct Option A - Hypok\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most effective stimulus for increasing aldosterone secretion ?", "options": [{"label": "A", "text": "Hyperkalemia", "correct": true}, {"label": "B", "text": "ACTH", "correct": false}, {"label": "C", "text": "Hypernatremia", "correct": false}, {"label": "D", "text": "Hyponatremia", "correct": false}], "correct_answer": "A. Hyperkalemia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Hyperk\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Conditions that alter <span class=\"customMeta\" data-dictid=\"210102fdef1692777181bab45bdfe3\">aldosterone</span> secretion</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>A. Conditions that increase secretion</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ol>\n<li>Hemorrhage</li>\n<li>Hypovolemia</li>\n<li>Hyperkalemia</li>\n<li>Hyponatremia</li>\n<li>Standing</li>\n<li>Anxiety</li>\n<li>Physical trauma and surgery</li>\n<li>Secondary hyperaldosteronism: <span class=\"customMeta\" data-dictid=\"210102fdef1692777181bab45bdfe3\">Aldosterone</span> <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> may increase in congestive heart failure, <span class=\"customMeta\" data-dictid=\"3e6e56aa3b1692777184226d2104e4\">cirrhosis</span> of liver, and nephritic syndrome.</li>\n</ol>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>B. Conditions that decrease secretion</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ol>\n<li>Expansion of <span class=\"customMeta\" data-dictid=\"3e06a6e5a216927771861914f2e75d\">ECF</span> volume</li>\n<li>Hypernatremia</li>\n<li>Hypokalemia</li>\n</ol>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "cGMP is the second messenger of", "options": [{"label": "A", "text": "Somatostatin", "correct": false}, {"label": "B", "text": "Angiotensin II", "correct": false}, {"label": "C", "text": "ADH", "correct": false}, {"label": "D", "text": "NO (nitric oxide)", "correct": true}], "correct_answer": "D. NO (nitric oxide)", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following options best represents 'very severe COPD' according to the GOLD criteria?", "options": [{"label": "A", "text": "FEV1/FVC &amp;lt;0.7 and FEV1&amp;lt;30%", "correct": true}, {"label": "B", "text": "FEV1/FVC &amp;lt;0.7 and FEV1&amp;lt;70%", "correct": false}, {"label": "C", "text": "FEV1/FVC &amp;lt;0.7 and FEV1&amp;lt;50%", "correct": false}, {"label": "D", "text": "Both a and c", "correct": false}], "correct_answer": "A. FEV1/FVC &lt;0.7 and FEV1&lt;30%", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - FEV1/FVC &amp;lt;0.7 and FEV1&amp;lt;30%:</p>\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Mild COPD</strong></p>\n</td>\n<td>\n<p>FEV1/ FVC&lt;0.7</p>\n</td>\n<td>\n<p>FEV1≥80%</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Moderate COPD</strong></p>\n</td>\n<td>\n<p>FEV1/ <span class=\"customMeta\" data-dictid=\"321620bde416927772037669a00aa5\">FVC</span> &lt;0.7</p>\n</td>\n<td>\n<p>FEV1 = 50-80%</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Severe COPD</strong></p>\n</td>\n<td>\n<p>FEV1/ <span class=\"customMeta\" data-dictid=\"321620bde416927772037669a00aa5\">FVC</span> &lt;0.7</p>\n</td>\n<td>\n<p>FEV1 = 30-50%</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Very sever COPD</strong></p>\n</td>\n<td>\n<p>FEV1/ <span class=\"customMeta\" data-dictid=\"321620bde416927772037669a00aa5\">FVC</span> &lt;0.7</p>\n</td>\n<td>\n<p>FEV1 &lt;30%</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Who is classified as a category III non-heart-beating donor?", "options": [{"label": "A", "text": "Dead on arrival", "correct": false}, {"label": "B", "text": "A patient who died after failed resuscitation after reaching the hospital", "correct": false}, {"label": "C", "text": "A patient who was bought dead to the hospital", "correct": false}, {"label": "D", "text": "A patient who is awaiting cardiac arrest in the hospital", "correct": true}], "correct_answer": "D. A patient who is awaiting cardiac arrest in the hospital", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - A patient who is awaiting &lt;span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\"&gt;cardiac&lt;/span&gt; arrest in the h\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>I</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dead on arrival</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Uncontrolled</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>II</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Unsuccessful resuscitation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Uncontrolled</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>III</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Awaiting <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrest</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Controlled</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>IV</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cardiac arrest while brain dead (death during procurement; death during explantation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Controlled</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following conditions is linked to AV block?", "options": [{"label": "A", "text": "Hypothyroidism", "correct": true}, {"label": "B", "text": "Cushing’s syndrome", "correct": false}, {"label": "C", "text": "Hyperthyroidism", "correct": false}, {"label": "D", "text": "Pheochromocytoma", "correct": false}], "correct_answer": "A. Hypothyroidism", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Hypoth\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What medication is employed for mass chemoprophylaxis in the case of meningococcal meningitis?", "options": [{"label": "A", "text": "Ciprofloxacin", "correct": true}, {"label": "B", "text": "Chloramphenicol", "correct": false}, {"label": "C", "text": "Tetracycline", "correct": false}, {"label": "D", "text": "Penicillin", "correct": false}], "correct_answer": "A. Ciprofloxacin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - C\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Nasopharyngeal chordoma arises from which of the following?", "options": [{"label": "A", "text": "Pharyngeal bursa", "correct": false}, {"label": "B", "text": "Notochord", "correct": true}, {"label": "C", "text": "Rathke's pouch", "correct": false}, {"label": "D", "text": "Luschka's bursa", "correct": false}], "correct_answer": "B. Notochord", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Notochord: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 303 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 299 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Which of the subsequent diseases demonstrate autosomal recessive inheritance?", "options": [{"label": "A", "text": "Albinism", "correct": true}, {"label": "B", "text": "G6PD deficiency", "correct": false}, {"label": "C", "text": "Marfan’s syndrome", "correct": false}, {"label": "D", "text": "Lesch-Nyhan syndrome", "correct": false}], "correct_answer": "A. Albinism", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - A\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:288px\">\n<p style=\"text-align: center;\"><strong>Autosomal Dominant Diseases</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:288px\">\n<p style=\"text-align: center;\"><strong>Autosomal <span class=\"customMeta\" data-dictid=\"d54db2110416927771971e7c011a9f\">Recessive</span> Diseases</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:288px\">\n<p style=\"text-align: center;\">Huntington's Disease</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:288px\">\n<p style=\"text-align: center;\">Cystic Fibrosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:288px\">\n<p style=\"text-align: center;\">Neurofibromatosis Type 1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:288px\">\n<p style=\"text-align: center;\">Phenylketonuria (PKU)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:288px\">\n<p style=\"text-align: center;\">Polycystic <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">Kidney</span> Disease</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:288px\">\n<p style=\"text-align: center;\">Tay-Sachs Disease</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:288px\">\n<p style=\"text-align: center;\">Osteogenesis Imperfecta</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:288px\">\n<p style=\"text-align: center;\">Sickle Cell Disease</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:288px\">\n<p style=\"text-align: center;\">Achondroplasia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:288px\">\n<p style=\"text-align: center;\">Albinism</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:288px\">\n<p style=\"text-align: center;\">Marfan's Syndrome</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:288px\">\n<p style=\"text-align: center;\">Hemochromatosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:288px\">\n<p style=\"text-align: center;\">Retinoblastoma</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:288px\">\n<p style=\"text-align: center;\">Hereditary Hemochromatosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:288px\">\n<p style=\"text-align: center;\">Myotonic Dystrophy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:288px\">\n<p style=\"text-align: center;\">Glycogen Storage Diseases</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:288px\">\n<p style=\"text-align: center;\">Familial Hypercholesterolemia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top; width:288px\">\n<p style=\"text-align: center;\">Hereditary Hemorrhagic Telangiectasia</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The movements at the _______ joint permit a person to look to the right and left", "options": [{"label": "A", "text": "Atlanto-occipital", "correct": false}, {"label": "B", "text": "Atlanto -axial", "correct": true}, {"label": "C", "text": "C2-C3", "correct": false}, {"label": "D", "text": "C3-C4", "correct": false}], "correct_answer": "B. Atlanto -axial", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following deficiencies leads to an elevation of glutamine levels in the bloodstream?", "options": [{"label": "A", "text": "Arginosuccinate lyase", "correct": false}, {"label": "B", "text": "Alpha-galactosidase-A", "correct": false}, {"label": "C", "text": "Ornithine transcarbamoylase", "correct": true}, {"label": "D", "text": "Arginase", "correct": false}], "correct_answer": "C. Ornithine transcarbamoylase", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is false regarding the right coronary artery?", "options": [{"label": "A", "text": "It’s diameter is less than left coronary artery", "correct": false}, {"label": "B", "text": "It arises from the right aortic sinus", "correct": false}, {"label": "C", "text": "It gives rise to circumflex coronary branch", "correct": true}, {"label": "D", "text": "Right conal artery is it’s first branch", "correct": false}], "correct_answer": "C. It gives rise to circumflex coronary branch", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which amino acid is essential for the conversion of nor-epinephrine to epinephrine among the following options?", "options": [{"label": "A", "text": "Tyrosine", "correct": false}, {"label": "B", "text": "Tryptophan", "correct": false}, {"label": "C", "text": "Phenylalanine", "correct": false}, {"label": "D", "text": "Methionine", "correct": true}], "correct_answer": "D. Methionine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Methyl acceptor</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Methylated product</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Norepinephrine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Epinephrine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Epinephrine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Metanephrine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Norepinephrine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normetanephrine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Serine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Choline</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Histidine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Methyl histidine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lysine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Methyl lysine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acetyl srotonin</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Melatonin</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the basis for the formation of omphaloceles?", "options": [{"label": "A", "text": "Excessive length of the intestine", "correct": false}, {"label": "B", "text": "Physiological hernia failing to go back", "correct": true}, {"label": "C", "text": "Herniation of liver", "correct": false}, {"label": "D", "text": "Herniation of umbilicus", "correct": false}], "correct_answer": "B. Physiological hernia failing to go back", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which fibre is marked by the arrow in the image given below?", "options": [{"label": "A", "text": "Short association", "correct": false}, {"label": "B", "text": "Long association", "correct": false}, {"label": "C", "text": "Projection", "correct": true}, {"label": "D", "text": "Commissural", "correct": false}], "correct_answer": "C. Projection", "question_images": ["https://image.prepladder.com/content/AuGsUpcEy9vkQ2kNRmno1714997698.png"], "explanation_images": ["https://image.prepladder.com/content/andYq0Qsu6AeCf1U5SaQ1716382402.png"], "explanation": "<p>Correct Option C - Proj\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following structures does not form the boundaries of the Calot triangle?", "options": [{"label": "A", "text": "Common hepatic duct", "correct": false}, {"label": "B", "text": "Cystic duct", "correct": false}, {"label": "C", "text": "Cystic artery", "correct": false}, {"label": "D", "text": "Gall bladder", "correct": true}], "correct_answer": "D. Gall bladder", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Area marked in the given image supplied by dermatome number?", "options": [{"label": "A", "text": "T8", "correct": false}, {"label": "B", "text": "T9", "correct": false}, {"label": "C", "text": "T10", "correct": true}, {"label": "D", "text": "T11", "correct": false}], "correct_answer": "C. T10", "question_images": ["https://image.prepladder.com/content/OatUlLUFE0C53z5y6n5O1694676314.png"], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dermatome Level</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Corresponding <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">Spinal</span> Nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Area of Innervation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T7</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thoracic <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> nerve 7</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Upper abdomen, just below the <span class=\"customMeta\" data-dictid=\"e2a43b79f416927772020606ce40fb\">xiphoid</span> process</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T8</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thoracic <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> nerve 8</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Upper abdomen, just below T7 dermatome</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T9</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thoracic <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> nerve 9</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Upper abdomen, just above the level of the <span class=\"customMeta\" data-dictid=\"c0c9f9bbda1692777201f1fd5464cb\">umbilicus</span> (belly button)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T10</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thoracic <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> nerve 10</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Area around the <span class=\"customMeta\" data-dictid=\"c0c9f9bbda1692777201f1fd5464cb\">umbilicus</span> (belly button)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T11</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thoracic <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> nerve 11</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lower abdomen, just below the T10 dermatome</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>T12</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thoracic <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> nerve 12</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lower abdomen, just above the <span class=\"customMeta\" data-dictid=\"fff48ca9da16927771966fd16bbacc\">pubic</span> region</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The arrow in the image denotes which of the following muscles?", "options": [{"label": "A", "text": "Extensor carpi radialis", "correct": true}, {"label": "B", "text": "Brachioradialis", "correct": false}, {"label": "C", "text": "Supinator", "correct": false}, {"label": "D", "text": "Flexor carpi radialis brevis", "correct": false}], "correct_answer": "A. Extensor carpi radialis", "question_images": ["https://image.prepladder.com/content/aFDYnHyOuFFdv0c5rFKG1691504696.png"], "explanation_images": ["https://image.prepladder.com/content/ihWEMhzVf09g2hTt9itP1715859165.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:598px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Muscle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Insertion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Action</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extensor carpi radialis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lateral <span class=\"customMeta\" data-dictid=\"9cdc5a92a216927771870d4b257a80\">epicondyle</span> of humerus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Base of the second and third <span class=\"customMeta\" data-dictid=\"3582e886271692777192ab233546a6\">metacarpal</span> bones</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extends and abducts the wrist</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extensor carpi ulnaris</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lateral <span class=\"customMeta\" data-dictid=\"9cdc5a92a216927771870d4b257a80\">epicondyle</span> of humerus, <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> border of ulna</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Base of the fifth <span class=\"customMeta\" data-dictid=\"3582e886271692777192ab233546a6\">metacarpal</span> bone</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extends and adducts the wrist</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extensor digitorum</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lateral <span class=\"customMeta\" data-dictid=\"9cdc5a92a216927771870d4b257a80\">epicondyle</span> of humerus, <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> surface of ulna</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extensor expansions of the fingers</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extends the fingers at the <span class=\"customMeta\" data-dictid=\"d7e158e089169277719265674b2879\">metacarpophalangeal</span> and <span class=\"customMeta\" data-dictid=\"65604d11831692777190c5ea442405\">interphalangeal</span> joints</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extensor <span class=\"customMeta\" data-dictid=\"71a5caf62116927771863da6f46ba3\">digiti</span> minimi</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lateral <span class=\"customMeta\" data-dictid=\"9cdc5a92a216927771870d4b257a80\">epicondyle</span> of humerus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dorsal aspect of the fifth digit</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extends the <span class=\"customMeta\" data-dictid=\"8226badd751692777203022e3dc57b\">fifth finger</span> at the <span class=\"customMeta\" data-dictid=\"d7e158e089169277719265674b2879\">metacarpophalangeal</span> and <span class=\"customMeta\" data-dictid=\"65604d11831692777190c5ea442405\">interphalangeal</span> joints</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extensor indicis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Posterior surface of ulna</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extensor expansion of the index finger</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extends the <span class=\"customMeta\" data-dictid=\"6ee643d13c1692777190386314a416\">index finger</span> at the <span class=\"customMeta\" data-dictid=\"d7e158e089169277719265674b2879\">metacarpophalangeal</span> and <span class=\"customMeta\" data-dictid=\"65604d11831692777190c5ea442405\">interphalangeal</span> joints</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extensor pollicis longus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Posterior surface of ulna, <span class=\"customMeta\" data-dictid=\"72b8cffc701692777190c03a6968ab\">interosseous</span> membrane</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Base of the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"e9451cd23d1692777195fe471f486e\">phalanx</span> of the thumb</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extends the thumb at the <span class=\"customMeta\" data-dictid=\"d7e158e089169277719265674b2879\">metacarpophalangeal</span> and <span class=\"customMeta\" data-dictid=\"65604d11831692777190c5ea442405\">interphalangeal</span> joints</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the nerve supply of the structure marked in the image below?", "options": [{"label": "A", "text": "Posterior interosseous nerve", "correct": false}, {"label": "B", "text": "Median nerve", "correct": true}, {"label": "C", "text": "Anterior interosseous nerve", "correct": false}, {"label": "D", "text": "Ulnar nerve", "correct": false}], "correct_answer": "B. Median nerve", "question_images": ["https://image.prepladder.com/content/jkXib3Ko3TWJJ6hmD1uZ1694676451.png"], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:598px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Distribution in Hand</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Median nerve</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Supplies the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> 2 lumbricals, <span class=\"customMeta\" data-dictid=\"48c587f4c51692777200fe869f1699\">thenar</span> muscles (except <span class=\"customMeta\" data-dictid=\"bebdf1cab81692777180c37e36596c\">adductor</span> pollicis), <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> 3 and a half digits (including <span class=\"customMeta\" data-dictid=\"e399ea3b4616927772004e16d5999d\">tips</span> of the index, middle, and half of the ring finger), <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">dorsal</span> aspects of the fingertips of the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> 3 and a half digits</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ulnar nerve</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Supplies the <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> 1 and a half lumbricals, <span class=\"customMeta\" data-dictid=\"33357d54b11692777189e2babd4674\">hypothenar</span> muscles, <span class=\"customMeta\" data-dictid=\"bebdf1cab81692777180c37e36596c\">adductor</span> pollicis, deep head of the <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">flexor</span> pollicis brevis, <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">dorsal</span> and <span class=\"customMeta\" data-dictid=\"236c57792f1692777194be265ad6db\">palmar</span> aspects of the little finger, <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> half of the ring finger, and the corresponding aspects of the fingertips</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Radial nerve</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Supplies the <span class=\"customMeta\" data-dictid=\"45f9bc42ac16927771871c9dc2970a\">extensor</span> muscles of the forearm, but no direct <span class=\"customMeta\" data-dictid=\"45b8853be116927771901a9ff3eeb2\">innervation</span> to the <span class=\"customMeta\" data-dictid=\"a6795c876e169277719057a1099465\">intrinsic</span> muscles of the hand (excluding the first <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">dorsal</span> interosseous)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Superficial branch of the <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> nerve</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Supplies the <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">dorsal</span> skin of the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> 2 and a half digits (excluding the fingertips)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dorsal branches of the <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> nerve</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Supplies the <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">dorsal</span> skin of the <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> 1 and a half digits (including the fingertips)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Nerve supply of the area marked by arrow in the image is:", "options": [{"label": "A", "text": "Radial nerve", "correct": true}, {"label": "B", "text": "Posterior interosseous nerve", "correct": false}, {"label": "C", "text": "Median nerve", "correct": false}, {"label": "D", "text": "Ulnar nerve", "correct": false}], "correct_answer": "A. Radial nerve", "question_images": ["https://image.prepladder.com/content/YnIvcKVSV2tXgKw18a591694676508.png"], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:598px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Distribution in <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">Dorsal</span> Hand</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Radial nerve</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Supplies the <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">dorsal</span> surface of the hand, including the <span class=\"customMeta\" data-dictid=\"f61866c72d169277718680f9c96ff2\">dorsum</span> of the fingers, thumb, and back of the hand.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Superficial branch of the <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> nerve</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Supplies the <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">dorsal</span> skin of the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> 2 and a half digits (excluding the fingertips).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dorsal branches of the <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> nerve</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Supplies the <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">dorsal</span> skin of the <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> 1 and a half digits (including the fingertips).</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following was separated by the cholecysto-vena caval line?", "options": [{"label": "A", "text": "Gallbladder and inferior vena cava", "correct": false}, {"label": "B", "text": "Porta hepatis and inferior vena cava", "correct": false}, {"label": "C", "text": "Caudate lobe and quadrangular lobe", "correct": false}, {"label": "D", "text": "Right and left lobe of liver", "correct": true}], "correct_answer": "D. Right and left lobe of liver", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is false about skin?", "options": [{"label": "A", "text": "Dermis is derived from ectoderm", "correct": true}, {"label": "B", "text": "Skin accounts for 15% of total body weight", "correct": false}, {"label": "C", "text": "Epidermis is derived from ectoderm", "correct": false}, {"label": "D", "text": "Dermis is made up of type 1 and type 3 collagen", "correct": false}], "correct_answer": "A. Dermis is derived from ectoderm", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following structures is not derived from the aponeurosis of the external oblique muscle?", "options": [{"label": "A", "text": "Pectineal ligament", "correct": false}, {"label": "B", "text": "Inguinal ligament", "correct": false}, {"label": "C", "text": "Lacunar ligament", "correct": false}, {"label": "D", "text": "Linea semilunaris", "correct": true}], "correct_answer": "D. Linea semilunaris", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"ad3a6758111692777191fa157f6ece\"&gt;Linea&lt;/span&gt; semilu\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Structure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Derived from <span class=\"customMeta\" data-dictid=\"52cb21596b1692777181aa72f1feb5\">aponeurosis</span> of <span class=\"customMeta\" data-dictid=\"787b0ec4661692777187c06c757e51\">external oblique</span> muscle</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inguinal ligament</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Yes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pectineal ligament</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Yes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lacunar ligament</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Yes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Linea alba</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Yes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Linea semilunaris</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anterior layer of <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> sheath</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Yes</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which lobe of the prostate is responsible for the formation of the uvula vesicae?", "options": [{"label": "A", "text": "Anterior", "correct": false}, {"label": "B", "text": "Posterior", "correct": false}, {"label": "C", "text": "Median", "correct": true}, {"label": "D", "text": "Lateral", "correct": false}], "correct_answer": "C. Median", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Foot drop is caused by damage to:", "options": [{"label": "A", "text": "Common peroneal nerve", "correct": true}, {"label": "B", "text": "Femoral nerve", "correct": false}, {"label": "C", "text": "Tibial nerve", "correct": false}, {"label": "D", "text": "Sciatic nerve", "correct": false}], "correct_answer": "A. Common peroneal nerve", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td colspan=\"2\">\n<p><strong>Nerve</strong></p>\n</td>\n<td>\n<p><strong>Lesion</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\">\n<p>Femoral Nerve</p>\n</td>\n<td>\n<p>Weakness of quadriceps, decreased knee jerk</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\">\n<p>Sciatic Nerve</p>\n</td>\n<td>\n<p>Foot drop, decreased ankle jerk</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\">\n<p>Common <span class=\"customMeta\" data-dictid=\"1e6451edc31692777195c54367b1ad\">Peroneal</span> Nerve</p>\n</td>\n<td>\n<p>Foot drop, <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> loss on the <span class=\"customMeta\" data-dictid=\"f61866c72d169277718680f9c96ff2\">dorsum</span> of the foot</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\">\n<p>Tibial Nerve</p>\n</td>\n<td>\n<p>Weakness of <span class=\"customMeta\" data-dictid=\"a7a430f3a9169277719510c13f434d\">plantar</span> flexors, <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> loss on the sole of the foot</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\">\n<p>Obturator Nerve</p>\n</td>\n<td>\n<p>Weakness of hip adductors, <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> loss in the <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> thigh</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the statements below accurately describes De Quervain's tenosynovitis?", "options": [{"label": "A", "text": "Fingers are held in mild extension", "correct": false}, {"label": "B", "text": "It affects APL and EPB", "correct": true}, {"label": "C", "text": "Most common involvement is index finger", "correct": false}, {"label": "D", "text": "Treatment is surgery", "correct": false}], "correct_answer": "B. It affects APL and EPB", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the structure marked B in the image given below:", "options": [{"label": "A", "text": "Pineal gland", "correct": false}, {"label": "B", "text": "Falx cerebri", "correct": false}, {"label": "C", "text": "Fornix", "correct": true}, {"label": "D", "text": "Pituitary gland", "correct": false}], "correct_answer": "C. Fornix", "question_images": ["https://image.prepladder.com/content/1re1CJIOjIHBvmcJCX6K1694676790.png"], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"a17eac40ea16927772034ca233cb84\"&gt;Fornix&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "1 st pharyngeal arch gives rise to all except:", "options": [{"label": "A", "text": "Medial pterygoids", "correct": false}, {"label": "B", "text": "Levator veli palatin", "correct": true}, {"label": "C", "text": "Lateral pterygoid", "correct": false}, {"label": "D", "text": "Tensor veli palatini", "correct": false}], "correct_answer": "B. Levator veli palatin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"fd8276624e169277719113f7a44b76\"&gt;Levator&lt;/span&gt; v\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Pharyngeal Arch</strong></p>\n</td>\n<td>\n<p><strong>Structures Derived</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>1st Pharyngeal Arch</p>\n</td>\n<td>\n<p>Maxillary process, Mandibular process, Meckel's cartilage, Muscles of <span class=\"customMeta\" data-dictid=\"7beec9567a1692777191ec123e0989\">mastication</span> (Temporalis, Masseter, <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">Medial</span> and <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> pterygoids), Mylohyoid, <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">Anterior</span> belly of digastric, <span class=\"customMeta\" data-dictid=\"72dbd9ec8716927772005127a031ac\">Tensor</span> tympani, <span class=\"customMeta\" data-dictid=\"72dbd9ec8716927772005127a031ac\">Tensor</span> veli palatini</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>2nd Pharyngeal Arch</p>\n</td>\n<td>\n<p>Reichert's cartilage, Stapes, <span class=\"customMeta\" data-dictid=\"29e4241b931692777199403b75a8e3\">Styloid</span> process, <span class=\"customMeta\" data-dictid=\"fb74018f561692777199b9f8cea159\">Stylohyoid</span> ligament, Muscles of <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> expression, <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">Posterior</span> belly of digastric, Stapedius</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>3rd Pharyngeal Arch</p>\n</td>\n<td>\n<p>Hyoid bone, Greater horn, Lower part of body, Stylopharyngeus muscle</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>4th Pharyngeal Arch</p>\n</td>\n<td>\n<p>Thyroid cartilage, <span class=\"customMeta\" data-dictid=\"ba164bcd07169277718502f7ba3457\">Cricoid</span> cartilage, <span class=\"customMeta\" data-dictid=\"fd8276624e169277719113f7a44b76\">Levator</span> veli palatini, <span class=\"customMeta\" data-dictid=\"ebe088dd1e1692777185885b701072\">Cricothyroid</span> muscle</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>6th Pharyngeal Arch</p>\n</td>\n<td>\n<p>Laryngeal cartilages (except <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> and cricoid), <span class=\"customMeta\" data-dictid=\"a6795c876e169277719057a1099465\">Intrinsic</span> muscles of the larynx</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the mechanism of action of the curare group of muscle relaxants?", "options": [{"label": "A", "text": "Persistently depolarizing at neuromuscular junction", "correct": false}, {"label": "B", "text": "Competitively blocking the binding of ACh to its receptors", "correct": true}, {"label": "C", "text": "Repetitive stimulation of ACh receptors on muscle endplate", "correct": false}, {"label": "D", "text": "Inhibiting the calcium channels on presynaptic membrane", "correct": false}], "correct_answer": "B. Competitively blocking the binding of ACh to its receptors", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Competitively &lt;span class=\"customMeta\" data-dictid=\"9dc12b322016927771830dff673eeb\"&gt;blocking&lt;/span&gt; the binding of &lt;span class=\"customMeta\" data-dictid=\"fba05f424716927771802b63f6c392\"&gt;ACh&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following intravenous anesthetics does not result in myocardial depression?", "options": [{"label": "A", "text": "Etomidate", "correct": true}, {"label": "B", "text": "Propofol", "correct": false}, {"label": "C", "text": "Thiopentone", "correct": false}, {"label": "D", "text": "Ketamine", "correct": false}], "correct_answer": "A. Etomidate", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A\n<table border=\"1\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>IV Anesthetic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Side Effects</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Propofol</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<ul>\n<li>Hypotension</li>\n<li>Respiratory depression</li>\n<li>Pain on injection</li>\n<li>Propofol <span class=\"customMeta\" data-dictid=\"3562d699c516927771909a426ea8ef\">infusion</span> syndrome (rare but serious)</li>\n<li>Allergic reactions</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Etomidate</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<ul>\n<li>Adrenal suppression</li>\n<li>Nausea and vomiting</li>\n<li>Myoclonus (muscle twitching)</li>\n<li>Pain on injection</li>\n<li>Transient skeletal muscle movements</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Thiopental</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<ul>\n<li>Respiratory depression</li>\n<li>Hypotension</li>\n<li>Histamine release</li>\n<li>Prolonged recovery</li>\n<li>Pain on injection</li>\n<li>Allergic reactions</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p>Ketamine</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<ul>\n<li>Emergence reactions (hallucinations, confusion)</li>\n<li>Increased heart rate and blood pressure</li>\n<li>Salivation and excessive secretions</li>\n<li>Nausea and vomiting</li>\n<li>Elevated <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> pressure (contraindicated)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not used for induction of anesthesia in pediatric patients?", "options": [{"label": "A", "text": "Halothane", "correct": false}, {"label": "B", "text": "Sevoflurane", "correct": false}, {"label": "C", "text": "Desflurane", "correct": true}, {"label": "D", "text": "Nitrous oxide", "correct": false}], "correct_answer": "C. Desflurane", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Desflu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following agents does not elicit pain on injection?", "options": [{"label": "A", "text": "Ketamine", "correct": true}, {"label": "B", "text": "Propofol", "correct": false}, {"label": "C", "text": "Etomidate", "correct": false}, {"label": "D", "text": "Thiopentone", "correct": false}], "correct_answer": "A. Ketamine", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which among the following is most commonly used to monitor the depth of anaesthesia?", "options": [{"label": "A", "text": "EEG", "correct": false}, {"label": "B", "text": "Provoked lower oesophageal contractility", "correct": false}, {"label": "C", "text": "Entropy", "correct": false}, {"label": "D", "text": "Bispectral index", "correct": true}], "correct_answer": "D. Bispectral index", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ZpVzm1YRK8Q43RkZMAXh1715663468.png"], "explanation": "<p>Correct Option D - Bispectral index (BIS)\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is measured by the device shown in the given image?", "options": [{"label": "A", "text": "Oxygen saturation", "correct": true}, {"label": "B", "text": "Oxygen content of the blood", "correct": false}, {"label": "C", "text": "Partial pressure of oxygen", "correct": false}, {"label": "D", "text": "Amount of inspired oxygen", "correct": false}], "correct_answer": "A. Oxygen saturation", "question_images": ["https://image.prepladder.com/content/tCWFiFtl1XNZGrqlNdd21715001261.png"], "explanation_images": [], "explanation": "<p>Correct Option A - Oxygen satu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During pregnancy, during which trimester is acute fatty liver most commonly observed?", "options": [{"label": "A", "text": "First trimester", "correct": false}, {"label": "B", "text": "Second trimester", "correct": false}, {"label": "C", "text": "Third trimester", "correct": true}, {"label": "D", "text": "Both a and b", "correct": false}], "correct_answer": "C. Third trimester", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is correct regarding alterations in the vagina during a typical pregnancy?", "options": [{"label": "A", "text": "Decreased number of Lactobacilli", "correct": false}, {"label": "B", "text": "Increased glycogen metabolism in the epithelium", "correct": true}, {"label": "C", "text": "pH &amp;gt; 6.", "correct": false}, {"label": "D", "text": "Epithelial thinning", "correct": false}], "correct_answer": "B. Increased glycogen metabolism in the epithelium", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During a routine ultrasound scan at 16 weeks, you identify indications of cardiac malformation in a fetus. At what fasting blood sugar level would you begin to suspect overt diabetes?", "options": [{"label": "A", "text": "106 mg/dL", "correct": false}, {"label": "B", "text": "126 mg/dL", "correct": true}, {"label": "C", "text": "116 mg/dL", "correct": false}, {"label": "D", "text": "130 mg/dL", "correct": false}], "correct_answer": "B. 126 mg/dL", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely diagnosis for a 45-year-old woman who has a lower abdominal mass and discomfort, with an examination revealing a uniformly enlarged uterus and free adnexa, and an MRI showing the presence of a myometrial cyst?", "options": [{"label": "A", "text": "Endometriosis", "correct": false}, {"label": "B", "text": "Adenomyosis", "correct": true}, {"label": "C", "text": "Leiomyoma", "correct": false}, {"label": "D", "text": "Endometrial hyperplasia", "correct": false}], "correct_answer": "B. Adenomyosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - A\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the subsequent options experiences a decrease during pregnancy?", "options": [{"label": "A", "text": "Respiratory rate", "correct": false}, {"label": "B", "text": "Vital capacity", "correct": false}, {"label": "C", "text": "Functional residual capacity", "correct": true}, {"label": "D", "text": "Inspiratory capacity", "correct": false}], "correct_answer": "C. Functional residual capacity", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Respiratory Volume</strong></p>\n</td>\n<td>\n<p><strong>Change During Pregnancy</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Tidal Volume</p>\n</td>\n<td>\n<p>Increases</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Inspiratory Reserve Volume</p>\n</td>\n<td>\n<p>Increases</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Expiratory Reserve Volume</p>\n</td>\n<td>\n<p>Increases</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Residual Volume</p>\n</td>\n<td>\n<p>Decreases</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Vital Capacity</p>\n</td>\n<td>\n<p>Increases</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Total Lung Capacity</p>\n</td>\n<td>\n<p>Increases</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following does not pose a contraindication for the initiation of labor?", "options": [{"label": "A", "text": "Pelvic tumor", "correct": false}, {"label": "B", "text": "Herpes infection", "correct": false}, {"label": "C", "text": "Intrauterine Growth Restriction", "correct": true}, {"label": "D", "text": "History of lower transverse cesarean section in last two pregnancies", "correct": false}], "correct_answer": "C. Intrauterine Growth Restriction", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the grade of placenta previa depicted in the provided image?", "options": [{"label": "A", "text": "IV", "correct": false}, {"label": "B", "text": "III", "correct": true}, {"label": "C", "text": "II", "correct": false}, {"label": "D", "text": "I", "correct": false}], "correct_answer": "B. III", "question_images": ["https://image.prepladder.com/content/tQ0MTaqTC4LsOa0KZU4G1695376781.png"], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is NOT a normal physiological change during pregnancy?", "options": [{"label": "A", "text": "Left axis deviation", "correct": false}, {"label": "B", "text": "Mild ST changes in inferior leads", "correct": false}, {"label": "C", "text": "Atrial and ventricular premature contractions", "correct": false}, {"label": "D", "text": "Pansystolic murmur", "correct": true}], "correct_answer": "D. Pansystolic murmur", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Cardiovascular Parameter</strong></p>\n</td>\n<td>\n<p><strong>Change during Pregnancy</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Blood Volume</strong></p>\n</td>\n<td>\n<p><strong>Gradual increase, reaching peak in the third trimester</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Cardiac Output</strong></p>\n</td>\n<td>\n<p><strong>Increase by approximately 30-50%</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Heart Rate</strong></p>\n</td>\n<td>\n<p><strong>Slight increase at rest</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Blood Pressure</strong></p>\n</td>\n<td>\n<p><strong>Decrease in the first and second trimesters, return to pre-pregnancy levels or slight increase in the third trimester</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Systemic <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">Vascular</span> Resistance</strong></p>\n</td>\n<td>\n<p><strong>Decrease</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Venous System</strong></p>\n</td>\n<td>\n<p><strong>Increased <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> pressure and decreased <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> return from lower extremities, increased risk of <span class=\"customMeta\" data-dictid=\"58bf762051169277720114fd8971a9\">varicose</span> veins and deep <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> thrombosis</strong></p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable diagnosis for a pregnant woman at 28 weeks of gestation, who has a fibroid uterus and is experiencing intense abdominal pain, but no fever, with a WBC count of 8000 cells/ul?", "options": [{"label": "A", "text": "Red degeneration of fibroid", "correct": true}, {"label": "B", "text": "Preterm labor", "correct": false}, {"label": "C", "text": "Torsion of fibroid", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "A. Red degeneration of fibroid", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Secondary Change</strong></p>\n</td>\n<td>\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Red Degeneration</strong></p>\n</td>\n<td>\n<p><strong>Hemorrhagic <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">infarction</span> of the fibroid, resulting in pain and enlargement</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Hyaline Degeneration</strong></p>\n</td>\n<td>\n<p><strong>Degenerative changes leading to the formation of <span class=\"customMeta\" data-dictid=\"a2ce88e8a0169277718988f5bc31b8\">hyaline</span> (smooth, glassy) areas within the fibroid</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Calcification</strong></p>\n</td>\n<td>\n<p><strong>Deposition of <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> within the fibroid, resulting in areas of increased density on <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> studies</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Cystic Degeneration</strong></p>\n</td>\n<td>\n<p><strong>Formation of fluid-filled cysts within the fibroid, causing <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> changes in its appearance</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Necrosis</strong></p>\n</td>\n<td>\n<p><strong>Tissue death within the fibroid, typically resulting from compromised blood supply or torsion</strong></p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the management of mastitis in a breastfeeding mother, what is the initial treatment approach?", "options": [{"label": "A", "text": "Dicloxacillin", "correct": true}, {"label": "B", "text": "Cefazolin", "correct": false}, {"label": "C", "text": "Ceftriaxone", "correct": false}, {"label": "D", "text": "Ampicillin", "correct": false}], "correct_answer": "A. Dicloxacillin", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Symptoms</strong></p>\n</td>\n<td>\n<p><strong>Management</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Breast pain and tenderness</strong></p>\n</td>\n<td>\n<p><strong>Apply warm compresses before breastfeeding; ensure proper <span class=\"customMeta\" data-dictid=\"5af45ba59c16927771837f3aa7b6d9\">breastfeeding</span> technique to ensure complete <span class=\"customMeta\" data-dictid=\"397f16a7a71692777187ffffefa7e6\">emptying</span> of the breast; pain relievers like <span class=\"customMeta\" data-dictid=\"95b7c54ee116927771809963c4ee14\">acetaminophen</span> or <span class=\"customMeta\" data-dictid=\"5778d7dc361692777189571125f0bd\">ibuprofen</span> as recommended</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Breast redness and warmth</strong></p>\n</td>\n<td>\n<p><strong>Continue <span class=\"customMeta\" data-dictid=\"5af45ba59c16927771837f3aa7b6d9\">breastfeeding</span> frequently to promote milk flow and clear the infection; apply warm compresses to the affected area; ensure proper latch and positioning during breastfeeding</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Breast engorgement</strong></p>\n</td>\n<td>\n<p><strong>Breastfeed or pump frequently to relieve pressure and empty the breast; apply cold compresses after <span class=\"customMeta\" data-dictid=\"11a5eea407169277720251b8446fa7\">feeding</span> to reduce swelling; avoid tight-fitting innerwear or clothing</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Flu-like symptoms (fever, body aches)</strong></p>\n</td>\n<td>\n<p><strong>Rest, stay hydrated, and get adequate nutrition; continue <span class=\"customMeta\" data-dictid=\"5af45ba59c16927771837f3aa7b6d9\">breastfeeding</span> or pumping to clear the infection; seek medical advice for appropriate management and possible <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> therapy</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Nipple pain or cracking</strong></p>\n</td>\n<td>\n<p><strong>Ensure correct latch and positioning during breastfeeding; use <span class=\"customMeta\" data-dictid=\"5b57c901de1692777191c1db4844d1\">lanolin</span> or other <span class=\"customMeta\" data-dictid=\"9fdffd913216927771936512ee5b2a\">nipple</span> creams to soothe and promote healing; seek assistance from a <span class=\"customMeta\" data-dictid=\"4abd8094e51692777191b1eb073735\">lactation</span> consultant if necessary</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Presence of <span class=\"customMeta\" data-dictid=\"e4626b4cea16927771968e59732fef\">pus</span> or abscess</strong></p>\n</td>\n<td>\n<p><strong>Antibiotic therapy may be necessary to treat the infection; <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> and <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> of <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> may be required in severe cases</strong></p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the primary source of amniotic fluid after 20 weeks of pregnancy?", "options": [{"label": "A", "text": "Fetal urine", "correct": true}, {"label": "B", "text": "Fetal skin", "correct": false}, {"label": "C", "text": "Fetal lung fluid", "correct": false}, {"label": "D", "text": "Maternal plasma", "correct": false}], "correct_answer": "A. Fetal urine", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Gestational Age</strong></p>\n</td>\n<td>\n<p><strong>Major Contributor to <span class=\"customMeta\" data-dictid=\"2c0fb943ce16927771815ddeb9824d\">Amniotic</span> Fluid</strong></p>\n</td>\n<td>\n<p><strong>Approximate <span class=\"customMeta\" data-dictid=\"2c0fb943ce16927771815ddeb9824d\">Amniotic</span> Fluid Volume</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>First Trimester</p>\n</td>\n<td>\n<p>Fetal lung fluid (pulmonary fluid, lung secretions)</p>\n</td>\n<td>\n<p>Around 25-75 mL</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Second Trimester</p>\n</td>\n<td>\n<p>Fetal urine</p>\n</td>\n<td>\n<p>Around 400-800 mL</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Third Trimester</p>\n</td>\n<td>\n<p>Fetal urine, lung fluid, and <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> plasma</p>\n</td>\n<td>\n<p>Around 800-1200 mL</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In low ovarian reserve, what would be the level of the anti-Mullerian hormone?", "options": [{"label": "A", "text": "&amp;lt;1", "correct": true}, {"label": "B", "text": "1-4", "correct": false}, {"label": "C", "text": "&amp;gt;7", "correct": false}, {"label": "D", "text": "&amp;gt;10", "correct": false}], "correct_answer": "A. &lt;1", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A) &\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>AMH Level (ng/mL)</strong></p>\n</td>\n<td>\n<p><strong>Interpretation</strong></p>\n</td>\n<td>\n<p><strong>Associated Disease/Condition</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>&lt;1</p>\n</td>\n<td>\n<p>Low ovarian reserve</p>\n</td>\n<td>\n<p>Diminished ovarian reserve</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>1-4</p>\n</td>\n<td>\n<p>Moderate to normal ovarian reserve</p>\n</td>\n<td>\n<p>Normal ovarian function</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>&gt;10</p>\n</td>\n<td>\n<p>High ovarian reserve</p>\n</td>\n<td>\n<p>Polycystic ovarian syndrome (PCOS) or tumors</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the highest dosage of PGF2 alpha recommended for treating postpartum hemorrhage?", "options": [{"label": "A", "text": "0.25 mg", "correct": false}, {"label": "B", "text": "2 mg", "correct": true}, {"label": "C", "text": "20 mg", "correct": false}, {"label": "D", "text": "200 mg", "correct": false}], "correct_answer": "B. 2 mg", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Indication</strong></p>\n</td>\n<td>\n<p><strong>Recommended Dose</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Induction of Labor</strong></p>\n</td>\n<td>\n<p><strong>Intramuscular: 0.25-0.5 mg</strong></p>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<p><strong>Intravenous: 0.25 mg</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Termination of Pregnancy (First Trimester)</strong></p>\n</td>\n<td>\n<p><strong>Intramuscular: 0.25 mg</strong></p>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<p><strong>Intravenous: 0.25 mg</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Postpartum Hemorrhage</strong></p>\n</td>\n<td>\n<p><strong>Intramuscular: 0.25-2 mg</strong></p>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<p><strong>Intravenous: 0.25 mg</strong></p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following conditions is not considered a gestational trophoblastic neoplasm?", "options": [{"label": "A", "text": "Partial mole", "correct": true}, {"label": "B", "text": "Choriocarcinoma", "correct": false}, {"label": "C", "text": "Placental site trophoblastic tumor", "correct": false}, {"label": "D", "text": "Invasive mole", "correct": false}], "correct_answer": "A. Partial mole", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Partial Mole: \n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the condition of the mother if the baby's appearance indicates that it was born at 34 weeks of pregnancy?", "options": [{"label": "A", "text": "Gestational diabetes", "correct": true}, {"label": "B", "text": "Rubella", "correct": false}, {"label": "C", "text": "Hypothyroidism", "correct": false}, {"label": "D", "text": "Gestational hypertension", "correct": false}], "correct_answer": "A. Gestational diabetes", "question_images": ["https://image.prepladder.com/content/yJAaFhjnQvFLQwRxyHhi1691507826.png"], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Clinical Features of GDM</strong></p>\n</td>\n<td>\n<p><strong>Explanation</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Glucose intolerance</p>\n</td>\n<td>\n<p>Elevated <span class=\"customMeta\" data-dictid=\"88b48cf7241692777183e5f5b8adf1\">blood sugar</span> levels during pregnancy, often detected during testing</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Excessive weight gain</p>\n</td>\n<td>\n<p>Greater than expected weight gain during pregnancy</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Polyhydramnios</p>\n</td>\n<td>\n<p>Increased <span class=\"customMeta\" data-dictid=\"2c0fb943ce16927771815ddeb9824d\">amniotic</span> fluid levels in the uterus</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Family history of diabetes</p>\n</td>\n<td>\n<p>A personal or family history of diabetes, including <span class=\"customMeta\" data-dictid=\"05e8c1df0d1692777201c9acee8b1f\">type 2</span> diabetes</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Previous history of GDM</p>\n</td>\n<td>\n<p>A history of <span class=\"customMeta\" data-dictid=\"6c82f5eada16927771886b38bad126\">gestational diabetes</span> in previous pregnancies</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Maternal age</p>\n</td>\n<td>\n<p>Advanced <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> age (over 35 years) increases the risk of GDM</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Polyuria and increased thirst</p>\n</td>\n<td>\n<p>Frequent <span class=\"customMeta\" data-dictid=\"01cdc9604816927772010d5f2b7e82\">urination</span> and excessive thirst</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Recurrent <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> or <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infection</p>\n</td>\n<td>\n<p>Frequent <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> or <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infections</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Gestational hypertension</p>\n</td>\n<td>\n<p>High <span class=\"customMeta\" data-dictid=\"263ee5444e1692777183a7e8e704da\">blood pressure</span> during pregnancy</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Pre-eclampsia</p>\n</td>\n<td>\n<p>Development of <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> and organ damage during pregnancy</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Large for <span class=\"customMeta\" data-dictid=\"2727bb69eb1692777188a09a87f2b8\">gestational age</span> (LGA)</p>\n</td>\n<td>\n<p>Baby's birth weight above the 90th <span class=\"customMeta\" data-dictid=\"8b22fa5ed1169277719587132297ce\">percentile</span> for gestational age</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Macrosomia-related complications</p>\n</td>\n<td>\n<p>Increased risk of birth injuries, shoulder dystocia, and C-section</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which hormone acts on the endometrium after ovulation?", "options": [{"label": "A", "text": "Luteinizing hormone", "correct": false}, {"label": "B", "text": "Follicular stimulating hormone", "correct": false}, {"label": "C", "text": "Progesterone", "correct": true}, {"label": "D", "text": "Oestrogen", "correct": false}], "correct_answer": "C. Progesterone", "question_images": ["https://image.prepladder.com/content/dEAijsmraB0ELXIjh20c1695377179.png"], "explanation_images": [], "explanation": "<p>Correct Option C - Prog\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Phase of <span class=\"customMeta\" data-dictid=\"3a03cad6c616927771925038b55989\">Menstrual</span> Cycle</strong></p>\n</td>\n<td>\n<p><strong>Hormone Levels</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Menstrual Phase(</strong><strong>3 to 7 days)</strong></p>\n</td>\n<td>\n<p><strong>Low levels of <span class=\"customMeta\" data-dictid=\"a58dd68b011692777187eb72633aac\">estrogen</span> and progesterone</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Follicular Phase(</strong><strong>10 to 14 days)</strong></p>\n</td>\n<td>\n<p><strong>Estrogen gradually increases</strong></p>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<p><strong>FSH (Follicle-Stimulating Hormone) increases</strong></p>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<p><strong>LH (Luteinizing Hormone) increases slightly near ovulation</strong></p>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<p><strong>Progesterone remains low</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Ovulation (</strong><strong>day 14 of a 28-day <span class=\"customMeta\" data-dictid=\"3a03cad6c616927771925038b55989\">menstrual</span> cycle)</strong></p>\n</td>\n<td>\n<p><strong>LH surges, causing ovulation</strong></p>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<p><strong>Estrogen reaches its peak</strong></p>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<p><strong>FSH decreases</strong></p>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<p><strong>Progesterone starts to increase</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Luteal Phase(</strong><strong>lasts 12-14 days before menstruation)</strong></p>\n</td>\n<td>\n<p><strong>Progesterone continues to increase</strong></p>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<p><strong>Estrogen starts to decline</strong></p>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<p><strong>LH decreases after ovulation</strong></p>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<p><strong>FSH remains low</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is an absolute contraindication to the use of oral contraceptive pills (OCPs)?", "options": [{"label": "A", "text": "Chronic renal disease", "correct": false}, {"label": "B", "text": "Thromboembolism", "correct": true}, {"label": "C", "text": "History of amenorrhea", "correct": false}, {"label": "D", "text": "Diabetes mellitus", "correct": false}], "correct_answer": "B. Thromboembolism", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Th\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Absolute Contraindications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Relative Contraindications</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>History of thromboembolic disorders</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Migraine headaches with aura</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Known or suspected breast cancer</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>History of gestational cholestasis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Liver disease or liver tumors</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Obesity and high blood pressure</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Undiagnosed <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> bleeding</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>History of <span class=\"customMeta\" data-dictid=\"3d885759d516927771966b84bfa470\">postpartum</span> <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> thrombosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pregnancy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Smokers over the age of 35</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> (high blood pressure)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diabetes mellitus with complications</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Active <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> hepatitis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Age over 35 with multiple <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> risk factors</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>History of ischemic heart disease or stroke</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the specific chromosome count observed in a partial hydatidiform mole?", "options": [{"label": "A", "text": "46 XX", "correct": false}, {"label": "B", "text": "45 XY", "correct": false}, {"label": "C", "text": "69 XY", "correct": false}, {"label": "D", "text": "69 XXY", "correct": true}], "correct_answer": "D. 69 XXY", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - 69 XXY\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most appropriate treatment for a 55-year-old woman who is experiencing third-degree uterine prolapse?", "options": [{"label": "A", "text": "Fothergill repair", "correct": false}, {"label": "B", "text": "Sling operation", "correct": false}, {"label": "C", "text": "Vaginal hysterectomy with pelvic floor repair", "correct": true}, {"label": "D", "text": "Shirodkar procedure", "correct": false}], "correct_answer": "C. Vaginal hysterectomy with pelvic floor repair", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\"&gt;Vaginal&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"633cf90e4016927771891fa018663e\"&gt;Hysterectomy&lt;/span&gt; with &lt;span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\"&gt;Pelvic&lt;/span&gt; Floor R\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In emergency contraception, what is the recommended dosage of Ulipristal?", "options": [{"label": "A", "text": "30 mg", "correct": true}, {"label": "B", "text": "300 mg", "correct": false}, {"label": "C", "text": "60 mg", "correct": false}, {"label": "D", "text": "600 mg", "correct": false}], "correct_answer": "A. 30 mg", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - 30 mg\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "When is the optimal period to assess nuchal translucency?", "options": [{"label": "A", "text": "6-8 weeks", "correct": false}, {"label": "B", "text": "11-14 weeks", "correct": true}, {"label": "C", "text": "14-16 weeks", "correct": false}, {"label": "D", "text": "16-20 weeks", "correct": false}], "correct_answer": "B. 11-14 weeks", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Trimester</strong></p>\n</td>\n<td>\n<p><strong>Ultrasound Examination</strong></p>\n</td>\n<td>\n<p><strong>Timing (in Weeks)</strong></p>\n</td>\n<td>\n<p><strong>Significance</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>First Trimester</p>\n</td>\n<td>\n<p>Transvaginal Ultrasound</p>\n</td>\n<td>\n<p>6-8 weeks</p>\n</td>\n<td>\n<p>- Confirming pregnancy and gestational age- Assessing <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> <span class=\"customMeta\" data-dictid=\"a8dece102f16927772026b199f06af\">viability</span> - Detecting multiple pregnancies - Evaluating <span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\">ectopic</span> pregnancies or miscarriages</p>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<p>Nuchal Translucency Ultrasound</p>\n</td>\n<td>\n<p>11-14 weeks</p>\n</td>\n<td>\n<p>- Screening for chromosomal abnormalities, such as Down syndrome</p>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<p>Dating Ultrasound</p>\n</td>\n<td>\n<p>8-12 weeks</p>\n</td>\n<td>\n<p>- Determining precise gestational age- Assessing <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> growth</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Second Trimester</p>\n</td>\n<td>\n<p>Anatomy Scan (Level 2 Ultrasound)</p>\n</td>\n<td>\n<p>18-20 weeks</p>\n</td>\n<td>\n<p>- Assessing <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> <span class=\"customMeta\" data-dictid=\"9e99effc421692777181b02606e021\">anatomy</span> and organ development - Detecting structural abnormalities</p>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<p>Fetal <span class=\"customMeta\" data-dictid=\"6e8fd9a9c516927771831be37cdf8c\">Biometry</span> Ultrasound</p>\n</td>\n<td>\n<p>Throughout the trimester</p>\n</td>\n<td>\n<p>- Monitoring <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> growth and well-being - Assessing <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> size, including head circumference, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> circumference, and <span class=\"customMeta\" data-dictid=\"512283ec9816927772024c89478b7d\">femur</span> length</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Third Trimester</p>\n</td>\n<td>\n<p>Growth Ultrasound</p>\n</td>\n<td>\n<p>Every 4-6 weeks from 28 weeks until birth</p>\n</td>\n<td>\n<p>- Assessing <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> growth and weight - Monitoring <span class=\"customMeta\" data-dictid=\"2c0fb943ce16927771815ddeb9824d\">amniotic</span> fluid levels</p>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<p>Doppler Ultrasound</p>\n</td>\n<td>\n<p>Throughout the trimester</p>\n</td>\n<td>\n<p>- Assessing <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> in the <span class=\"customMeta\" data-dictid=\"9cc3973459169277720194a0847477\">umbilical</span> cord and <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> vessels - Monitoring <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> function</p>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<p>BPP (Biophysical Profile) Ultrasound</p>\n</td>\n<td>\n<p>Typically from 32 weeks until birth</p>\n</td>\n<td>\n<p>- Assessing <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> well-being, including <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> movements, breathing, muscle tone, <span class=\"customMeta\" data-dictid=\"2c0fb943ce16927771815ddeb9824d\">amniotic</span> fluid volume, and heart rate</p>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<p>Presentation Scan</p>\n</td>\n<td>\n<p>Around 36 weeks</p>\n</td>\n<td>\n<p>- Determining <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> presentation (head-down or breech) in preparation for delivery</p>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<p>Position and <span class=\"customMeta\" data-dictid=\"5276da31d11692777195f0e82f5e1d\">Placenta</span> Ultrasound</p>\n</td>\n<td>\n<p>Throughout the trimester</p>\n</td>\n<td>\n<p>- Assessing <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> location and <span class=\"customMeta\" data-dictid=\"ba06b6179a16927771925370a2760c\">maturity</span> - Checking for <span class=\"customMeta\" data-dictid=\"5276da31d11692777195f0e82f5e1d\">placenta</span> previa or other <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> abnormalities</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Magnesium sulphate has no role in which of the following ?", "options": [{"label": "A", "text": "Prevention of seizures in severe pre-eclampsia", "correct": false}, {"label": "B", "text": "Prevention of recurrent seizures in eclampsia", "correct": false}, {"label": "C", "text": "Prevention of RDS premature baby", "correct": true}, {"label": "D", "text": "Reducing contractility of uterus", "correct": false}], "correct_answer": "C. Prevention of RDS premature baby", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C- Prevention of RDS (Respiratory &lt;span class=\"customMeta\" data-dictid=\"afafb9026e1692777186e3dd168fa8\"&gt;Distress&lt;/span&gt; Syndrome) in &lt;span class=\"customMeta\" data-dictid=\"84f13673191692777196762b18e036\"&gt;premature&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the vertex presentation with complete flexion attitude of the head, which of the following is observed?", "options": [{"label": "A", "text": "Suboccipito-bregmatic diameter", "correct": true}, {"label": "B", "text": "Suboccipito-frontal diameter", "correct": false}, {"label": "C", "text": "Occipito-frontal diamete", "correct": false}, {"label": "D", "text": "Occipito-posterior position", "correct": false}], "correct_answer": "A. Suboccipito-bregmatic diameter", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Engaging Diameter</strong></p>\n</td>\n<td>\n<p><strong>Presentation</strong></p>\n</td>\n<td>\n<p><strong>Length of Diameter</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Suboccipito-bregmatic diameter</p>\n</td>\n<td>\n<p>Vertex presentation (Head-first)</p>\n</td>\n<td>\n<p>9.5 cm</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Submento-vertical diameter</p>\n</td>\n<td>\n<p>Face presentation</p>\n</td>\n<td>\n<p>11.5 cm</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Biparietal diameter</p>\n</td>\n<td>\n<p>Vertex presentation (Head-first)</p>\n</td>\n<td>\n<p>9.5 cm</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Bitemporal diameter</p>\n</td>\n<td>\n<p>Vertex presentation (Head-first)</p>\n</td>\n<td>\n<p>8 cm</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Suboccipito-frontal diameter</p>\n</td>\n<td>\n<p>Vertex presentation (Head-first)</p>\n</td>\n<td>\n<p>10 cm</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Occipito-frontal diameter</p>\n</td>\n<td>\n<p>Vertex presentation (Head-first)</p>\n</td>\n<td>\n<p>11.5 cm</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most suitable treatment option for a pregnant woman who has a history of multiple miscarriages and has been recently diagnosed with antiphospholipid antibody syndrome?", "options": [{"label": "A", "text": "Aspirin only", "correct": false}, {"label": "B", "text": "Aspirin + heparin", "correct": true}, {"label": "C", "text": "Heparin + steroids", "correct": false}, {"label": "D", "text": "Aspirin+steroids", "correct": false}], "correct_answer": "B. Aspirin + heparin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option B: &lt;span class=\"customMeta\" data-dictid=\"deba671f4716927771828c95a320e5\"&gt;Aspirin&lt;/span&gt; + H\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Clinical Features</strong></p>\n</td>\n<td>\n<p><strong>Management</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Recurrent pregnancy loss</strong></p>\n</td>\n<td>\n<p><strong>- <span class=\"customMeta\" data-dictid=\"deba671f4716927771828c95a320e5\">Aspirin</span> (60-80 mg/day)</strong></p>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<p><strong>- Low <span class=\"customMeta\" data-dictid=\"b2df2436bf1692777193d90e9c0132\">molecular weight</span> <span class=\"customMeta\" data-dictid=\"050e27829716927771885eddb2620c\">heparin</span> (LMWH) starting before pregnancy and continuing throughout pregnancy</strong></p>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<p><strong>- Close monitoring of pregnancy with regular <span class=\"customMeta\" data-dictid=\"df077f2c3d16927772019f8223e58f\">ultrasound</span> and <span class=\"customMeta\" data-dictid=\"eb476e70a316927771861ad68beaae\">Doppler</span> assessments</strong></p>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<p><strong>- Consideration of additional therapies, such as corticosteroids, <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> <span class=\"customMeta\" data-dictid=\"f8fab286571692777189bdfd087071\">immunoglobulin</span> (IVIG)</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Venous <span class=\"customMeta\" data-dictid=\"237b2a1dfa1692777200a074fd1072\">thromboembolism</span> (DVT, PE)</strong></p>\n</td>\n<td>\n<p><strong>- <span class=\"customMeta\" data-dictid=\"b5fc7729f316927771817f809648f5\">Anticoagulant</span> therapy with LMWH or warfarin, depending on the individual case</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Arterial <span class=\"customMeta\" data-dictid=\"237b2a1dfa1692777200a074fd1072\">thromboembolism</span> (stroke, MI)</strong></p>\n</td>\n<td>\n<p><strong>- <span class=\"customMeta\" data-dictid=\"b5fc7729f316927771817f809648f5\">Anticoagulant</span> therapy with LMWH or warfarin, depending on the individual case</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Thrombocytopenia</strong></p>\n</td>\n<td>\n<p><strong>- Treatment guided by the severity and clinical context</strong></p>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<p><strong>- Consideration of corticosteroids or other <span class=\"customMeta\" data-dictid=\"c3c986cd721692777189b473814b2e\">immunosuppressive</span> therapies</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Other manifestations (e.g., <span class=\"customMeta\" data-dictid=\"53f2eb017116927771918255da4e8b\">livedo</span> reticularis, neurological symptoms)</strong></p>\n</td>\n<td>\n<p><strong>- Treatment based on the specific manifestations and severity</strong></p>\n</td>\n</tr>\n<tr>\n<td> </td>\n<td>\n<p><strong>- Management may include anticoagulation, <span class=\"customMeta\" data-dictid=\"c3c986cd721692777189b473814b2e\">immunosuppressive</span> therapy, and <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> treatment</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What should be the subsequent approach to treat a pregnant woman, aged 22, who continues to have a fever despite being prescribed antibiotics, and is later diagnosed with septic pelvic thrombophlebitis?", "options": [{"label": "A", "text": "Stop antibiotics and start heparin", "correct": false}, {"label": "B", "text": "Antibiotics+Heparin", "correct": true}, {"label": "C", "text": "Surgical embolectomy", "correct": false}, {"label": "D", "text": "Hysterectomy", "correct": false}], "correct_answer": "B. Antibiotics+Heparin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Antibiotics + H\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "For a woman experiencing itching due to atrophic vaginitis, which treatment option is preferred?", "options": [{"label": "A", "text": "Steroids", "correct": false}, {"label": "B", "text": "Topical estrogen", "correct": true}, {"label": "C", "text": "Antihistamines only", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "B. Topical estrogen", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"9c5b45e3b916927772000167f2669a\"&gt;Topical&lt;/span&gt; estrog\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 15-year-old girl presents with itchy lesions on her arm as shown. Her family history is positive for asthma. What could be the most probable diagnosis?", "options": [{"label": "A", "text": "Seborrhoeic dermatitis", "correct": false}, {"label": "B", "text": "Atopic dermatitis", "correct": true}, {"label": "C", "text": "Allergic contact dermatitis", "correct": false}, {"label": "D", "text": "Erysipelas", "correct": false}], "correct_answer": "B. Atopic dermatitis", "question_images": ["https://image.prepladder.com/content/I09qgAo9nUmrYmSp3cSo1713789595.png"], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"afad60190f1692777182663499dc42\"&gt;Atopic&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Bindi Leucoderm a is caused by which chemical?", "options": [{"label": "A", "text": "A Mono-benzyl ether of Hydroquinone (MBH)", "correct": false}, {"label": "B", "text": "Crocein Scarlet MOO and Solvent Yellow 3", "correct": false}, {"label": "C", "text": "p-phenylenediamine (PPD)", "correct": false}, {"label": "D", "text": "Para Tertiary butylphenol (PTBP)", "correct": true}], "correct_answer": "D. Para Tertiary butylphenol (PTBP)", "question_images": ["https://image.prepladder.com/content/ZFld8MjqIPcVzhVtF1ET1713789648.png"], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"d420f34d5816927771943f346531fc\"&gt;Para&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"22e8a6f65016927772003e97740ab2\"&gt;Tertiary&lt;/span&gt; butylphenol (PTBP)\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most frequently encountered cause of the condition shown in the image below?", "options": [{"label": "A", "text": "Vaccination", "correct": false}, {"label": "B", "text": "Malignancy", "correct": false}, {"label": "C", "text": "Drugs", "correct": false}, {"label": "D", "text": "Infection", "correct": true}], "correct_answer": "D. Infection", "question_images": ["https://image.prepladder.com/content/GtUeZ76KbZSUbgD9IkiV1713955364.png"], "explanation_images": [], "explanation": "<p>Correct Option D - I\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young female presented with vaginal itching and green frothy genital discharge. Strawberry vagina is seen on examination. What will be the drug of choice?", "options": [{"label": "A", "text": "Doxycycline", "correct": false}, {"label": "B", "text": "Oral fluconazole", "correct": false}, {"label": "C", "text": "Metronidazole", "correct": true}, {"label": "D", "text": "Azithromycin", "correct": false}], "correct_answer": "C. Metronidazole", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"452c41e7811692777192cd0d89fdc7\"&gt;Metronidazole&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the accurate statement regarding the diagnosis made from the provided image?", "options": [{"label": "A", "text": "The lesions are not infectious", "correct": false}, {"label": "B", "text": "Trigeminal dermatome is most commonly affected", "correct": false}, {"label": "C", "text": "Anterior nerve roots are more commonly involved", "correct": false}, {"label": "D", "text": "Mucous membranes within the affected dermatomes are involved", "correct": true}], "correct_answer": "D. Mucous membranes within the affected dermatomes are involved", "question_images": ["https://image.prepladder.com/content/ht0lfo97UtgnpYyXQQCn1713955472.png"], "explanation_images": [], "explanation": "<p>Correct Option D - Mucous membranes within the affected dermatomes are involv\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What will be the diagnosis of the image provided below?", "options": [{"label": "A", "text": "Candidal paronychia", "correct": false}, {"label": "B", "text": "Staphylococcal scalded skin syndrome", "correct": false}, {"label": "C", "text": "Candidal intertrigo", "correct": true}, {"label": "D", "text": "Diabetic foot ulce", "correct": false}], "correct_answer": "C. Candidal intertrigo", "question_images": ["https://image.prepladder.com/content/MkLmsr62CL3lYV957PfD1713955523.png"], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"63f131c596169277718339c44d22f6\"&gt;Candidal&lt;/span&gt; intertrig\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the common association with the condition depicted below?", "options": [{"label": "A", "text": "Oil drop sign", "correct": false}, {"label": "B", "text": "Leukonychia striata", "correct": false}, {"label": "C", "text": "Pterygium of nails", "correct": false}, {"label": "D", "text": "Pitting of nails", "correct": true}], "correct_answer": "D. Pitting of nails", "question_images": ["https://image.prepladder.com/content/rUyQgGp3XQLDSVVQT5jD1691480080.png"], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"a8c53e6875169277719588cd709854\"&gt;Pitting&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the conditio n given in the image:", "options": [{"label": "A", "text": "Dermatomyositis", "correct": false}, {"label": "B", "text": "Acanthosis nigrican", "correct": true}, {"label": "C", "text": "Pityriasis rotunda", "correct": false}, {"label": "D", "text": "Melasma", "correct": false}], "correct_answer": "B. Acanthosis nigrican", "question_images": ["https://image.prepladder.com/content/GXc9tYuzcmf9zrDPVHtT1710480283.png", "https://image.prepladder.com/content/QTNxHEETBI97zbgncQYk1710480287.png"], "explanation_images": [], "explanation": "<p>Correct Option B - Acanthosis nig\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In cerebrohepatorenal syndrome, an infant exhibits symptoms of hypotonia and seizures. The condition is characterized by the accumulation of which substance in the brain?", "options": [{"label": "A", "text": "Glucose", "correct": false}, {"label": "B", "text": "Long chain fatty acid", "correct": true}, {"label": "C", "text": "Lactic acid", "correct": false}, {"label": "D", "text": "Triglycerides", "correct": false}], "correct_answer": "B. Long chain fatty acid", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which substrate of the Krebs cycle is diminished by an excess amount of ammonia?", "options": [{"label": "A", "text": "Malate", "correct": false}, {"label": "B", "text": "Oxaloacetate", "correct": false}, {"label": "C", "text": "Fumarate", "correct": false}, {"label": "D", "text": "Alpha ketoglutarate", "correct": true}], "correct_answer": "D. Alpha ketoglutarate", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is autosomal dominant?", "options": [{"label": "A", "text": "Cystic fibrosis", "correct": false}, {"label": "B", "text": "Duchene muscular dystrophy", "correct": false}, {"label": "C", "text": "Sickle cell anaemia", "correct": false}, {"label": "D", "text": "Achondroplasia", "correct": true}], "correct_answer": "D. Achondroplasia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Ach\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which enzymes are affected in Menke's disease?", "options": [{"label": "A", "text": "Lysyl hydroxylase", "correct": false}, {"label": "B", "text": "Lysyl oxidase", "correct": true}, {"label": "C", "text": "Prolyl oxidase", "correct": false}, {"label": "D", "text": "Prolyl hydroxylase", "correct": false}], "correct_answer": "B. Lysyl oxidase", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the shared precursor amino acid for urea, creatinine, and nitric oxide?", "options": [{"label": "A", "text": "Glycine", "correct": false}, {"label": "B", "text": "Arginine", "correct": true}, {"label": "C", "text": "Aspartate", "correct": false}, {"label": "D", "text": "Alanine", "correct": false}], "correct_answer": "B. Arginine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Amino Acid</strong></p>\n</td>\n<td>\n<p><strong>Derivatives</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Arginine</p>\n</td>\n<td>\n<ul>\n<li>Urea (through the <span class=\"customMeta\" data-dictid=\"38d4be106e169277720105b006c26b\">urea</span> cycle)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<ul>\n<li>Creatinine</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<ul>\n<li>Nitric oxide</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Aspartate</p>\n</td>\n<td>\n<ul>\n<li>Urea (through the <span class=\"customMeta\" data-dictid=\"38d4be106e169277720105b006c26b\">urea</span> cycle)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "True regarding mitochondrial genome:", "options": [{"label": "A", "text": "Maternal inheritance", "correct": true}, {"label": "B", "text": "Low rate of mutation", "correct": false}, {"label": "C", "text": "Single stranded DNA", "correct": false}, {"label": "D", "text": "Paternal inheritance", "correct": false}], "correct_answer": "A. Maternal inheritance", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Maternal inh\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "After consuming a fatty meal, what is elevated in individuals with lipoprotein lipase deficiency?", "options": [{"label": "A", "text": "Chylomicron", "correct": true}, {"label": "B", "text": "LDL", "correct": false}, {"label": "C", "text": "HDL", "correct": false}, {"label": "D", "text": "Apo A", "correct": false}], "correct_answer": "A. Chylomicron", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is reduced in urine in a patient with Wilson's disease?", "options": [{"label": "A", "text": "Tyrosine", "correct": false}, {"label": "B", "text": "Phosphorous", "correct": false}, {"label": "C", "text": "Serine", "correct": false}, {"label": "D", "text": "3-methylhistidine", "correct": true}], "correct_answer": "D. 3-methylhistidine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - 3-methylh\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "NADPH is used in which of the following process?", "options": [{"label": "A", "text": "Fatty acid synthesis", "correct": true}, {"label": "B", "text": "Ketone synthesis", "correct": false}, {"label": "C", "text": "Gluconeogenesis", "correct": false}, {"label": "D", "text": "Glycolysis", "correct": false}], "correct_answer": "A. Fatty acid synthesis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:384px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Reducing Equivalent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Main Uses</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>NADH (Nicotinamide <span class=\"customMeta\" data-dictid=\"701cef29c216927771801e7d1a7c0f\">adenine</span> dinucleotide)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Electron carrier in <span class=\"customMeta\" data-dictid=\"60d563fe241692777194203742bf5b\">oxidative</span> <span class=\"customMeta\" data-dictid=\"619ba5e99c16927771958308fb8687\">phosphorylation</span> (ATP synthesis)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>NADPH (Nicotinamide <span class=\"customMeta\" data-dictid=\"701cef29c216927771801e7d1a7c0f\">adenine</span> <span class=\"customMeta\" data-dictid=\"419082b5c61692777186e04b66aafb\">dinucleotide</span> phosphate)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1. <span class=\"customMeta\" data-dictid=\"3e0d247aa916927771812684526ac0\">Anabolic</span> reactions, such as <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> acid synthesis</p>\n<p>2. Reductive biosynthesis, including cholesterol and <span class=\"customMeta\" data-dictid=\"a48ce797cd1692777199efc43b3e4c\">steroid</span> hormone synthesis</p>\n<p>3. <span class=\"customMeta\" data-dictid=\"a14911da6d1692777186ec6f3025a1\">Detoxification</span> reactions by <span class=\"customMeta\" data-dictid=\"29e8e2a5dd16927771855db589c581\">cytochrome</span> P450 enzymes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>FADH2 (Flavin <span class=\"customMeta\" data-dictid=\"701cef29c216927771801e7d1a7c0f\">adenine</span> dinucleotide)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Electron carrier in <span class=\"customMeta\" data-dictid=\"60d563fe241692777194203742bf5b\">oxidative</span> <span class=\"customMeta\" data-dictid=\"619ba5e99c16927771958308fb8687\">phosphorylation</span> (ATP synthesis)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>FMNH2 (Flavin mononucleotide)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Electron carrier in <span class=\"customMeta\" data-dictid=\"60d563fe241692777194203742bf5b\">oxidative</span> <span class=\"customMeta\" data-dictid=\"619ba5e99c16927771958308fb8687\">phosphorylation</span> (ATP synthesis)</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following does not characterize tubercular otitis media?", "options": [{"label": "A", "text": "Ear ache", "correct": true}, {"label": "B", "text": "Multiple perforations", "correct": false}, {"label": "C", "text": "Pale granulation", "correct": false}, {"label": "D", "text": "Foul smelling ear discharge", "correct": false}], "correct_answer": "A. Ear ache", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Ear ach\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is accurate regarding keratosis obturans?", "options": [{"label": "A", "text": "Failure of migration of desquamated epithelium along posterior meatal wall", "correct": false}, {"label": "B", "text": "Widening of meatus and facial nerve palsy might be seen", "correct": false}, {"label": "C", "text": "Associated bronchiectasis and sinusitis", "correct": false}, {"label": "D", "text": "All of the above", "correct": true}], "correct_answer": "D. All of the above", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following best describes Pott’s puffy tumor ?", "options": [{"label": "A", "text": "Subperiosteal abscess of frontal bone", "correct": true}, {"label": "B", "text": "Subperiosteal abscess of ethmoid bone", "correct": false}, {"label": "C", "text": "Mucocele of frontal bone", "correct": false}, {"label": "D", "text": "Mucocele of ethmoid bone", "correct": false}], "correct_answer": "A. Subperiosteal abscess of frontal bone", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Subperiosteal &lt;span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\"&gt;abscess&lt;/span&gt; of &lt;span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\"&gt;frontal&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the lesion of vocal cord in the image given below:", "options": [{"label": "A", "text": "Reinke’s edema", "correct": false}, {"label": "B", "text": "Malignancy", "correct": false}, {"label": "C", "text": "Tracheomalacia", "correct": false}, {"label": "D", "text": "Laryngeal papilloma", "correct": true}], "correct_answer": "D. Laryngeal papilloma", "question_images": ["https://image.prepladder.com/content/OXBYqlhHfzCBcy9sBl5T1713502592.png"], "explanation_images": ["https://image.prepladder.com/content/nUegIkglAnjBmS9qSmYm1713502606.png"], "explanation": "<p>Correct option D. Laryngeal papilloma.</p>\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Clinical Features</strong></p>\n</td>\n<td>\n<p><strong>Management Options</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Benign growth</p>\n</td>\n<td>\n<p>Regular monitoring of growth and symptoms</p>\n<p>Surgical removal of papillomas</p>\n<p>Adjuvant therapies such as laser treatment or cryotherapy</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Caused by <span class=\"customMeta\" data-dictid=\"6bca6e988d1692777189167b791930\">HPV</span> infection</p>\n</td>\n<td>\n<p>Vaccination against <span class=\"customMeta\" data-dictid=\"6bca6e988d1692777189167b791930\">HPV</span> (for prevention)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Wart-like or grape-like projections</p>\n</td>\n<td>\n<p>Voice therapy and vocal cord exercises</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Hoarseness</p>\n</td>\n<td>\n<p>Voice therapy and vocal cord exercises</p>\n<p>Surgical removal of papillomas</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Stridor</p>\n<p>Breathing difficulties</p>\n</td>\n<td>\n<p>Airway management and emergency intervention</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What type of lesions are associated with the presence of inspiratory stridor?", "options": [{"label": "A", "text": "Supraglottic", "correct": true}, {"label": "B", "text": "Subglottic", "correct": false}, {"label": "C", "text": "Tracheal", "correct": false}, {"label": "D", "text": "Bronchus", "correct": false}], "correct_answer": "A. Supraglottic", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A. Inspiratory &lt;span class=\"customMeta\" data-dictid=\"c8af142f48169277719965c593fa0b\"&gt;stridor&lt;/span&gt; is commonly found in &lt;span class=\"customMeta\" data-dictid=\"7813a61d5816927771991abd685f88\"&gt;supraglottic&lt;/span&gt; lesions.\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Type of Stridor</strong></p>\n</td>\n<td>\n<p><strong>Origin</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Inspiratory</p>\n</td>\n<td>\n<ul>\n<li>Supraglottic Lesions</li>\n<li>Pharynx</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Expiratory</p>\n</td>\n<td>\n<p>Thoracic <span class=\"customMeta\" data-dictid=\"9ebd78bd471692777200ede69e8ed1\">trachea</span> and bronchi</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Biphasic</p>\n</td>\n<td>\n<ul>\n<li>Glottis</li>\n<li>Subglottis</li>\n<li>Cervical trachea</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "BCYE medium is used to culture:", "options": [{"label": "A", "text": "Leptospira", "correct": false}, {"label": "B", "text": "Bacillus cereus", "correct": false}, {"label": "C", "text": "Campylobacter", "correct": false}, {"label": "D", "text": "Legionella", "correct": true}], "correct_answer": "D. Legionella", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Leg\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 16-year-old boy is admitted with fever, icterus, conjunctival injection, and hematuria for 15 days . Which serological test should be done for diagnosis?", "options": [{"label": "A", "text": "Widal test", "correct": false}, {"label": "B", "text": "Microscopic agglutination test", "correct": true}, {"label": "C", "text": "Weil felix reaction", "correct": false}, {"label": "D", "text": "Paul Bunnell test", "correct": false}], "correct_answer": "B. Microscopic agglutination test", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Microscopic &lt;span class=\"customMeta\" data-dictid=\"36e1a07ab01692777180db73f01e84\"&gt;Agglutination&lt;/span&gt; T\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with gastrointestinal problems including abdominal pain and distension , bloody and mucus-filled diarrhea, and tenesmus, with rectal prolapse . A stool examination reveals the presence of typical barrel-shaped eggs . What is the possible causative agent ?", "options": [{"label": "A", "text": "Giardia lamblia", "correct": false}, {"label": "B", "text": "Trichuris trichiura", "correct": true}, {"label": "C", "text": "Ascaris lumbricoides", "correct": false}, {"label": "D", "text": "Ancylostoma duodenale", "correct": false}], "correct_answer": "B. Trichuris trichiura", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/0DAzYeQVuBNI2ukrBXxl1713267766.png"], "explanation": "<p>Correct Option B - Trichuris Trichiu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Viral infection mimicking erythroblastosis fetalis is:", "options": [{"label": "A", "text": "HSV", "correct": false}, {"label": "B", "text": "Epstein-Barr virus", "correct": false}, {"label": "C", "text": "Picornavirus", "correct": false}, {"label": "D", "text": "Parvovirus B19", "correct": true}], "correct_answer": "D. Parvovirus B19", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"4c37b9980316927771941adbff3e43\"&gt;Parvovirus&lt;/span&gt; B19\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely diagnosis for an 11-year-old boy who presented at the pediatric outpatient department with multiple abscesses on his face, chest, and back, along with a history of frequent respiratory infections. Uponexamination, the child showed signs of atopic excoriating skin and multiple cold abscesses on his back.", "options": [{"label": "A", "text": "Hyper IgM syndrome", "correct": false}, {"label": "B", "text": "Wiskott-Aldrich syndrome", "correct": false}, {"label": "C", "text": "Hyper IgE syndrome", "correct": true}, {"label": "D", "text": "Carcinoid syndrome", "correct": false}], "correct_answer": "C. Hyper IgE syndrome", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"8b388efd711692777189df2d1fc1e4\"&gt;Hyper&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"a54166a5961692777189c5557f61f3\"&gt;IgE&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Cowdry Type A inclusion s are seen in:", "options": [{"label": "A", "text": "Herpes simplex", "correct": true}, {"label": "B", "text": "Rabies", "correct": false}, {"label": "C", "text": "Molluscum contagiosum", "correct": false}, {"label": "D", "text": "Adenovirus", "correct": false}], "correct_answer": "A. Herpes simplex", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Herpes simplex:</p>\n<table cellspacing=\"0\">\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Inclusion Bodies and Viruses Producing Them </strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Intracytoplasmic <span class=\"customMeta\" data-dictid=\"c3b8b9a17416927771906b1bebb13c\">inclusion</span> bodies </strong></p>\n<ul>\n<li>Negri bodies – <span class=\"customMeta\" data-dictid=\"1486544453169277719764b31c563f\">rabies</span> virus</li>\n<li>Paschen body – <span class=\"customMeta\" data-dictid=\"79abf2d9eb1692777201fafa22ab07\">variola</span> virus</li>\n<li>Guamieri bodies – <span class=\"customMeta\" data-dictid=\"92af8db8a116927772011711df3c11\">vaccinia</span> virus</li>\n<li>Bollinger bodies – <span class=\"customMeta\" data-dictid=\"8c2e8f942016927772039102ac940b\">fowlpox</span> virus</li>\n<li>Molluscum bodies – <span class=\"customMeta\" data-dictid=\"3c4e017ee21692777192753aa09ff6\">molluscum</span> contagiosum virus</li>\n<li>Perinuclear cytoplasmic body – reovirus</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Intranuclear <span class=\"customMeta\" data-dictid=\"c3b8b9a17416927771906b1bebb13c\">Inclusion</span> Bodies </strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"1\">\n<p><strong>Cowdry <span class=\"customMeta\" data-dictid=\"10b0d1c12d16927772018830011368\">type A</span> inclusions </strong></p>\n<ul>\n<li>Torres body – yellow fever virus</li>\n<li>Lipschutz body – <span class=\"customMeta\" data-dictid=\"e502fd2a6816927771880ae17fc163\">herpes</span> simplex virus</li>\n</ul>\n<p><strong>Cowdry <span class=\"customMeta\" data-dictid=\"0dddac147b1692777201460ab59600\">type B</span> inclusions </strong></p>\n<ul>\n<li>Poliovirus</li>\n<li>Adenovirus</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Intracytoplasmic and <span class=\"customMeta\" data-dictid=\"9a24821bc91692777190bba334f1a6\">Intranuclear</span> <span class=\"customMeta\" data-dictid=\"c3b8b9a17416927771906b1bebb13c\">Inclusion</span> Bodies </strong></p>\n<ul>\n<li>Owl’s eye appearance – cytomegalovirus</li>\n<li>Measles virus</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\">\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Inclusion Bodies and Viruses Producing them </strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Intracytoplasmic <span class=\"customMeta\" data-dictid=\"c3b8b9a17416927771906b1bebb13c\">inclusion</span> bodies </strong></p>\n<ul>\n<li>Negri bodies – <span class=\"customMeta\" data-dictid=\"1486544453169277719764b31c563f\">rabies</span> virus</li>\n<li>Paschen body – <span class=\"customMeta\" data-dictid=\"79abf2d9eb1692777201fafa22ab07\">variola</span> virus</li>\n<li>Guamieri bodies – <span class=\"customMeta\" data-dictid=\"92af8db8a116927772011711df3c11\">vaccinia</span> virus</li>\n<li>Bollinger bodies – <span class=\"customMeta\" data-dictid=\"8c2e8f942016927772039102ac940b\">fowlpox</span> virus</li>\n<li>Molluscum bodies – <span class=\"customMeta\" data-dictid=\"3c4e017ee21692777192753aa09ff6\">molluscum</span> contagiosum virus</li>\n<li>Perinuclear cytoplasmic body – reovirus</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Intranuclear <span class=\"customMeta\" data-dictid=\"c3b8b9a17416927771906b1bebb13c\">Inclusion</span> Bodies </strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"1\">\n<p><strong>Cowdry <span class=\"customMeta\" data-dictid=\"10b0d1c12d16927772018830011368\">type A</span> inclusions </strong></p>\n<ul>\n<li>Torres body – yellow fever virus</li>\n<li>Lipschutz body – <span class=\"customMeta\" data-dictid=\"e502fd2a6816927771880ae17fc163\">herpes</span> simplex virus</li>\n</ul>\n<p><strong>Cowdry <span class=\"customMeta\" data-dictid=\"0dddac147b1692777201460ab59600\">type B</span> inclusions </strong></p>\n<ul>\n<li>Poliovirus</li>\n<li>Adenovirus</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Intracytoplasmic and <span class=\"customMeta\" data-dictid=\"9a24821bc91692777190bba334f1a6\">Intranuclear</span> <span class=\"customMeta\" data-dictid=\"c3b8b9a17416927771906b1bebb13c\">Inclusion</span> Bodies </strong></p>\n<ul>\n<li>Owl’s eye appearance – cytomegalovirus</li>\n<li>Measles virus</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the technique shown in the provided image?", "options": [{"label": "A", "text": "Epley’s maneuvre", "correct": false}, {"label": "B", "text": "Trotter’s method", "correct": true}, {"label": "C", "text": "McGovern’s technique", "correct": false}, {"label": "D", "text": "Valsalva maneuvre", "correct": false}], "correct_answer": "B. Trotter’s method", "question_images": ["https://image.prepladder.com/content/A0myYqIinOFCxITFlHHx1691504792.png"], "explanation_images": ["https://image.prepladder.com/content/EktSy7Ulc5jxM6PmmCtd1713443943.png"], "explanation": "<p>Correct Option B - Trotter’s meth\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What would be the recommended treatment for simple myopic astigmatism among the options provided?", "options": [{"label": "A", "text": "+1.00 DS", "correct": false}, {"label": "B", "text": "-1.00 DC × 180 Degree", "correct": true}, {"label": "C", "text": "-1.00 DS", "correct": false}, {"label": "D", "text": "-1.00DS – 1.00 DC × 180 Degree", "correct": false}], "correct_answer": "B. -1.00 DC × 180 Degree", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option B: -1.00 DC × 180 Deg\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:575px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Axis I</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Axis II</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type of Astigmatism</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Simple hypermetropic</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Simple myopic</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Compound hypermetropic</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Compound myopic</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mixed</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the appropriate treatment for ptosis resulting from Horner's syndrome?", "options": [{"label": "A", "text": "Blaskowic’s operation", "correct": false}, {"label": "B", "text": "Frontalis Sling operation", "correct": false}, {"label": "C", "text": "Fasanella servat operation", "correct": true}, {"label": "D", "text": "Everbusch’s operation", "correct": false}], "correct_answer": "C. Fasanella servat operation", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Fasanella-Serv\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not true about retinitis pigmentosa?", "options": [{"label": "A", "text": "Retinal pigmentation", "correct": false}, {"label": "B", "text": "Pale waxy disc", "correct": false}, {"label": "C", "text": "Narrowing of vessels", "correct": false}, {"label": "D", "text": "ERG – normal", "correct": true}], "correct_answer": "D. ERG – normal", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"2a080283331692777187f1a881e3d1\"&gt;ERG&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most frequently observed eye manifestation in this disease in a 45-year-old patient who presents with progressive weakness throughout the day and is found to possess antibodies against nicotinic acetylcholine receptors?", "options": [{"label": "A", "text": "Miosis", "correct": false}, {"label": "B", "text": "Lagophthalmos", "correct": false}, {"label": "C", "text": "Exophthalmos", "correct": false}, {"label": "D", "text": "Ptosis", "correct": true}], "correct_answer": "D. Ptosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - P\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What would be your diagnosis for a patient who has a previous trauma history and is currently experiencing diplopia and following findings on CT?", "options": [{"label": "A", "text": "Le-fort fracture", "correct": false}, {"label": "B", "text": "Fracture maxilla", "correct": false}, {"label": "C", "text": "Fracture zygomatic", "correct": false}, {"label": "D", "text": "Blow out fracture", "correct": true}], "correct_answer": "D. Blow out fracture", "question_images": ["https://image.prepladder.com/content/UaB1ZQr7YF10j8j9NCOO1715758628.png"], "explanation_images": [], "explanation": "<p>Correct Option D - Blowout Fractu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely diagnosis from the image given below?", "options": [{"label": "A", "text": "Pinguecula", "correct": false}, {"label": "B", "text": "Concretions", "correct": false}, {"label": "C", "text": "Pterygium", "correct": true}, {"label": "D", "text": "Bitot's spots", "correct": false}], "correct_answer": "C. Pterygium", "question_images": ["https://image.prepladder.com/content/ie9iOms4Qz0AQ6PqFGBp1691505622.png"], "explanation_images": [], "explanation": "<p>Correct Option C - Pterygiu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is not true in relation to accommodative esotropia?", "options": [{"label": "A", "text": "It is the most common type of squint", "correct": false}, {"label": "B", "text": "Miotics are used as the treatment strategy in the high AC/A ratio", "correct": false}, {"label": "C", "text": "It is associated with high myopia", "correct": true}, {"label": "D", "text": "Refractive type can be fully corrected by use of spectacles", "correct": false}], "correct_answer": "C. It is associated with high myopia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - It is associated with high\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the commonly used chemotherapy regimen for the treatment of retinoblastoma?", "options": [{"label": "A", "text": "Vinblastine, etoposide and bleomycin", "correct": false}, {"label": "B", "text": "Vinblastine, vincristine and etoposide", "correct": false}, {"label": "C", "text": "Vinblastine, vincristine and cisplatin", "correct": false}, {"label": "D", "text": "Vincristine, carboplatin and etoposide", "correct": true}], "correct_answer": "D. Vincristine, carboplatin and etoposide", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Vincristine, carboplatin,\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the name of the device as shown in the image, used for the management of the glaucoma ?", "options": [{"label": "A", "text": "Ex-Press TM implant", "correct": true}, {"label": "B", "text": "Ahmed glaucoma valve", "correct": false}, {"label": "C", "text": "Molteno implant", "correct": false}, {"label": "D", "text": "Baerveldt implant", "correct": false}], "correct_answer": "A. Ex-Press TM implant", "question_images": ["https://image.prepladder.com/content/JDla4a3WiUDgGqgghpUG1695190401.png"], "explanation_images": ["https://image.prepladder.com/content/DEwAoUtIIgCtyzzYFjJd1715058070.png", "https://image.prepladder.com/content/ysNMxRamN5btTAKM9B201715057001.png"], "explanation": "<p>Correct Option A - Ex-PressTM\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the instrument.", "options": [{"label": "A", "text": "Maddox wing", "correct": false}, {"label": "B", "text": "Stenopic slit", "correct": false}, {"label": "C", "text": "Maddox rod", "correct": true}, {"label": "D", "text": "Phoropter", "correct": false}], "correct_answer": "C. Maddox rod", "question_images": ["https://image.prepladder.com/content/2u4EYeoCsIJSCVG8Hych1691506915.png"], "explanation_images": ["https://image.prepladder.com/content/BiWah2kFiYIFeO5QBstA1715248459.png", "https://image.prepladder.com/content/bRM4tsxztLFpJ0CQt4VY1715255144.png", "https://image.prepladder.com/content/l97XGNgnsCijaHvJeUTJ1715248484.png"], "explanation": "<p>Correct Option C - M\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the test being shown below.", "options": [{"label": "A", "text": "Obscure test", "correct": false}, {"label": "B", "text": "Prism test", "correct": false}, {"label": "C", "text": "Cover uncover test", "correct": true}, {"label": "D", "text": "Maddox rod test", "correct": false}], "correct_answer": "C. Cover uncover test", "question_images": ["https://image.prepladder.com/content/KDE9hYDj7cJrUDfGlyoV1695190732.png", "https://image.prepladder.com/content/T9gAaYKi02JoUN0S1ktA1695190739.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All of the following are features of fragile X syndrome, except :", "options": [{"label": "A", "text": "Trinucleotide mutation in FMR-1 gene", "correct": false}, {"label": "B", "text": "Mental retardation", "correct": false}, {"label": "C", "text": "Microorchidism", "correct": true}, {"label": "D", "text": "Large everted ears", "correct": false}], "correct_answer": "C. Microorchidism", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Microorch\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/uCPWpgc2YWxSTIPzfwNf1748372942.mp3", "video": ""}, {"text": "Predominantly osteoblastic secondaries are seen in which of the following?", "options": [{"label": "A", "text": "Prostate carcinoma", "correct": true}, {"label": "B", "text": "Breast carcinoma", "correct": false}, {"label": "C", "text": "Stomach carcinoma", "correct": false}, {"label": "D", "text": "Bone carcinoma", "correct": false}], "correct_answer": "A. Prostate carcinoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\"&gt;Prostate&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old man is found to have hepatomegaly on physical examination. He also complains of a dark tan despite avoiding sun exposure . His liver microscopy is given on the slide below. This patient most likely suffers from which condition ?", "options": [{"label": "A", "text": "Wilson’s disease", "correct": false}, {"label": "B", "text": "Autoimmune hepatitis", "correct": false}, {"label": "C", "text": "Alpha-1 antitrypsin deficiency", "correct": false}, {"label": "D", "text": "Hemochromatosis", "correct": true}], "correct_answer": "D. Hemochromatosis", "question_images": ["https://image.prepladder.com/content/AK5JBliTdJdFkGOXYqJ21691505746.png"], "explanation_images": [], "explanation": "<p>Correct Option D - Hemoch\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Punched-out ulcers in the esophagus are caused by which of the following?", "options": [{"label": "A", "text": "Herpes simplex virus", "correct": true}, {"label": "B", "text": "Cytomegalovirus", "correct": false}, {"label": "C", "text": "Candida", "correct": false}, {"label": "D", "text": "Gastric acid", "correct": false}], "correct_answer": "A. Herpes simplex virus", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"e502fd2a6816927771880ae17fc163\"&gt;Herpes&lt;/span&gt; simplex viru\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\">\n<tbody>\n<tr>\n<td><strong>HSV esophagitis</strong></td>\n<td>Shallow, well-demarcated ulcers with a <span class=\"customMeta\" data-dictid=\"7134f7f8681692777196fa644c43bf\">punched-out</span> appearance</td>\n</tr>\n<tr>\n<td><strong>CMV esophagitis</strong></td>\n<td>Linear or linearly arranged shallow ulcers</td>\n</tr>\n<tr>\n<td><strong>Candida esophagitis</strong></td>\n<td>Raised, white plaques or pseudomembranes</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Alpha-1 antitrypsin is the major inhibitor of which enzyme ?", "options": [{"label": "A", "text": "Catalase", "correct": false}, {"label": "B", "text": "Collagenase", "correct": false}, {"label": "C", "text": "Elastase", "correct": true}, {"label": "D", "text": "Phospholipase", "correct": false}], "correct_answer": "C. Elastase", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - E\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/5abR3SgzS27LQPe78wCJ1748373088.mp3", "video": ""}, {"text": "All is true about the Barrett oesophagus , except ?", "options": [{"label": "A", "text": "Complication of chronic GERD", "correct": false}, {"label": "B", "text": "Seen in 10% of individuals with symptomatic GERD", "correct": false}, {"label": "C", "text": "Increases risk of squamous cell carcinoma", "correct": true}, {"label": "D", "text": "Intestinal metaplasia", "correct": false}], "correct_answer": "C. Increases risk of squamous cell carcinoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Increases the risk of &lt;span class=\"customMeta\" data-dictid=\"5be0ee4ea316927771997104326685\"&gt;squamous&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following diseases is most commonly associated with Down syndrome?", "options": [{"label": "A", "text": "Parkinson Disease", "correct": false}, {"label": "B", "text": "Alzheimer disease", "correct": true}, {"label": "C", "text": "Schizophrenia", "correct": false}, {"label": "D", "text": "Huntington disease", "correct": false}], "correct_answer": "B. Alzheimer disease", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Alzh\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ctybOYTxZ0967JzAoUVL1748414652.mp3", "video": ""}, {"text": "Which of the following statements is true regarding the modified Duke’s criteria?", "options": [{"label": "A", "text": "Single positive blood culture for HACEK group is a major criterion", "correct": false}, {"label": "B", "text": "Single positive blood culture for Coxiella burnetti is a major criterion", "correct": true}, {"label": "C", "text": "Complete dehiscence of prosthetic valve", "correct": false}, {"label": "D", "text": "Documentation of four minor criteria allows a clinical diagnosis", "correct": false}], "correct_answer": "B. Single positive blood culture for Coxiella burnetti is a major criterion", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Single positive &lt;span class=\"customMeta\" data-dictid=\"590c4f61381692777183624596f6ed\"&gt;blood culture&lt;/span&gt; for &lt;span class=\"customMeta\" data-dictid=\"c9ed7c1a9f1692777185cc193f7ec1\"&gt;Coxiella&lt;/span&gt; burnetti is a maj\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "IL-1 is activated by:", "options": [{"label": "A", "text": "Caspase-1", "correct": true}, {"label": "B", "text": "Caspase-3", "correct": false}, {"label": "C", "text": "Caspase-9", "correct": false}, {"label": "D", "text": "Caspase-8", "correct": false}], "correct_answer": "A. Caspase-1", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - C\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/6ogDQIwn67ac8mebVnpR1747055101.mp3", "video": ""}, {"text": "Flask shaped ulcers in the colon are caused by:", "options": [{"label": "A", "text": "Entamoeba histolytica", "correct": true}, {"label": "B", "text": "Giardia lamblia", "correct": false}, {"label": "C", "text": "Helicobacter pylori", "correct": false}, {"label": "D", "text": "Entamoeba vermicularis", "correct": false}], "correct_answer": "A. Entamoeba histolytica", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"b444d7821b16927771873fcd26a46e\"&gt;Entamoeba&lt;/span&gt; H\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is true about fever?", "options": [{"label": "A", "text": "Aspirin increases fever by inhibiting prostaglandin synthesis", "correct": false}, {"label": "B", "text": "PGD2 is responsible for resetting the temperature to a higher level", "correct": false}, {"label": "C", "text": "IL-1 is an endogenous pyrogen", "correct": true}, {"label": "D", "text": "Fever occurs during inflammation due to release of histamine", "correct": false}], "correct_answer": "C. IL-1 is an endogenous pyrogen", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - IL-1 is an &lt;span class=\"customMeta\" data-dictid=\"2a7f0b780c1692777187fe83ec76b1\"&gt;endogenous&lt;/span&gt; pyrog\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/a2ECbQhTWTNOaFL38CO81747055329.mp3", "video": ""}, {"text": "Identify the anti-apoptotic factor among the following:", "options": [{"label": "A", "text": "p53", "correct": false}, {"label": "B", "text": "KRAS", "correct": false}, {"label": "C", "text": "Bcl-2", "correct": true}, {"label": "D", "text": "BAK", "correct": false}], "correct_answer": "C. Bcl-2", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Bcl-2\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td style=\"text-align:center\"><strong>Anti-apoptotic factors</strong></td>\n<td style=\"text-align:center\"><strong>Pro-apoptotic factors</strong></td>\n</tr>\n<tr>\n<td style=\"text-align:center\">Bcl-2</td>\n<td style=\"text-align:center\">BAX</td>\n</tr>\n<tr>\n<td style=\"text-align:center\">Bcl-xL</td>\n<td style=\"text-align:center\">BAK</td>\n</tr>\n<tr>\n<td style=\"text-align:center\">MCL-1</td>\n<td style=\"text-align:center\">BAD</td>\n</tr>\n<tr>\n<td style=\"text-align:center\">XIAP</td>\n<td style=\"text-align:center\">BID</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the type of necrosis seen in the vessel wall of a patient with polyarteritis nodosa?", "options": [{"label": "A", "text": "Fibrinoid necrosis", "correct": true}, {"label": "B", "text": "Gangrenous necrosis", "correct": false}, {"label": "C", "text": "Fat necrosis", "correct": false}, {"label": "D", "text": "Caseous necrosis", "correct": false}], "correct_answer": "A. Fibrinoid necrosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"43b1f01822169277720222a3b354dd\"&gt;Fibrinoid&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is a risk factor for Alzheimer’s disease?", "options": [{"label": "A", "text": "Apo E1", "correct": false}, {"label": "B", "text": "Apo E2", "correct": false}, {"label": "C", "text": "Apo E3", "correct": false}, {"label": "D", "text": "Apo E4", "correct": true}], "correct_answer": "D. Apo E4", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Apo E4\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Alcohol abuse is strongly associated with the development of which of the following condition?", "options": [{"label": "A", "text": "Pericarditis", "correct": false}, {"label": "B", "text": "Hypertrophic cardiomyopathy", "correct": false}, {"label": "C", "text": "Dilated cardiomyopathy", "correct": true}, {"label": "D", "text": "Myocarditis", "correct": false}], "correct_answer": "C. Dilated cardiomyopathy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Dilated cardiomyopath\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which lymphoma is strongly associated with overexpression of Bcl-2?", "options": [{"label": "A", "text": "Follicular lymphoma", "correct": true}, {"label": "B", "text": "Burkitt lymphoma", "correct": false}, {"label": "C", "text": "Diffuse large cell lymphoma", "correct": false}, {"label": "D", "text": "Chronic lymphocytic leukemia", "correct": false}], "correct_answer": "A. Follicular lymphoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"031a38f17a16927772036476ede2ae\"&gt;Follicular&lt;/span&gt; lymph\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely diagnosis based on the provided X-ray image, along with normal clinical examination, hematological, and urinary test results, in a 65-year-old male patient?", "options": [{"label": "A", "text": "Multiple myeloma", "correct": false}, {"label": "B", "text": "Langerhans cell histiocytosis", "correct": true}, {"label": "C", "text": "Metastasis", "correct": false}, {"label": "D", "text": "Hyperparathyroidism", "correct": false}], "correct_answer": "B. Langerhans cell histiocytosis", "question_images": ["https://image.prepladder.com/content/P1QrhExVa0QhqbS3G1lS1693991276.png"], "explanation_images": [], "explanation": "<p>Correct option B. Langerhans cell histiocytosis.\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Radiological Manifestations</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Punched-out <span class=\"customMeta\" data-dictid=\"d54da38aaa1692777191560f60c0f9\">lytic</span> lesions</p>\n</td>\n<td>\n<p>Well-defined, round or <span class=\"customMeta\" data-dictid=\"74793d564816927771943ae4ba74b3\">oval</span> areas of bone destruction</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Geographic bone lesions</p>\n</td>\n<td>\n<p>Expansile areas of bone destruction with well-defined borders</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Erlenmeyer <span class=\"customMeta\" data-dictid=\"017d1c6af716927772025c04337815\">flask</span> deformity</p>\n</td>\n<td>\n<p>Flaring and widening of the <span class=\"customMeta\" data-dictid=\"8ccb80bd4d169277719296d80e2193\">metaphysis</span> in long bones</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Bone cysts</p>\n</td>\n<td>\n<p>Cystic areas within the bone with thinning of the <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> bone</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Vertebra plana</p>\n</td>\n<td>\n<p>Most common cause of <span class=\"customMeta\" data-dictid=\"89cd4b5bf716927772010247b57941\">vertebra</span> <span class=\"customMeta\" data-dictid=\"2d0756b0d11692777195ef3bcd110d\">plana</span> in children</p>\n<p>Mostly seen in <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> spine</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 47-year-old female patient with a long-standing history of rheumatic heart disease was admitted to the hospital due to severe breathlessness . She died on the third day following admission. The mitral valve shows the following findings on autopsy. What is the cause of these findings?", "options": [{"label": "A", "text": "Rupture of valve", "correct": false}, {"label": "B", "text": "Calcification and fibrosis", "correct": true}, {"label": "C", "text": "Hypertrophy of ventricular wall", "correct": false}, {"label": "D", "text": "Hypertrophy of the atrial wall", "correct": false}], "correct_answer": "B. Calcification and fibrosis", "question_images": ["https://image.prepladder.com/content/hFPGiYY3o27fZbknjOE31698317227.png"], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"a1ee14c673169277718351bfe6afd4\"&gt;Calcification&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following myocardial infarcts causes aneurysm as a post-MI complication?", "options": [{"label": "A", "text": "Subendocardial", "correct": false}, {"label": "B", "text": "Anterior transmural", "correct": true}, {"label": "C", "text": "Posterior transmural", "correct": false}, {"label": "D", "text": "Inferior wall", "correct": false}], "correct_answer": "B. Anterior transmural", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\"&gt;Anterior&lt;/span&gt; transmu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which drug listed below is utilized as an agent for smoking cessation?", "options": [{"label": "A", "text": "Busulfan", "correct": false}, {"label": "B", "text": "Acamprosate", "correct": false}, {"label": "C", "text": "Varenicline", "correct": true}, {"label": "D", "text": "Gabapentin", "correct": false}], "correct_answer": "C. Varenicline", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - V\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements about somnambulism is incorrec t?", "options": [{"label": "A", "text": "Disorder of sleep arousal", "correct": false}, {"label": "B", "text": "Person will have full consciousness", "correct": true}, {"label": "C", "text": "Usually, terminates in awakening followed by confusion", "correct": false}, {"label": "D", "text": "There may be neurological condition associated", "correct": false}], "correct_answer": "B. Person will have full consciousness", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Person will have full consciou\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which one of the options does not contribute as a risk factor for delusional disorder?", "options": [{"label": "A", "text": "Recent immigration", "correct": false}, {"label": "B", "text": "Social isolation", "correct": false}, {"label": "C", "text": "Family history", "correct": false}, {"label": "D", "text": "Young age", "correct": true}], "correct_answer": "D. Young age", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D. Young age.\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Premature ejaculation is a disorder of which phase of the normal sexual cycle ?", "options": [{"label": "A", "text": "Desire", "correct": false}, {"label": "B", "text": "Arousal", "correct": false}, {"label": "C", "text": "Orgasm", "correct": true}, {"label": "D", "text": "Pain", "correct": false}], "correct_answer": "C. Orgasm", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Org\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Phase of Sexual Cycle</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Sexual Disorders</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Desire</p>\n</td>\n<td>\n<p>Hypoactive Sexual Desire Disorder (HSDD), Sexual Aversion Disorder</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Arousal</p>\n</td>\n<td>\n<p>Female Sexual <span class=\"customMeta\" data-dictid=\"bf639c9a2316927771825e1632d9fb\">Arousal</span> Disorder (FSAD), Male <span class=\"customMeta\" data-dictid=\"5cc2a2112e16927771874c5d97065a\">Erectile</span> Disorder (Erectile Dysfunction)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Orgasm</p>\n</td>\n<td>\n<p>Premature Ejaculation, Delayed Ejaculation, Female Orgasmic Disorder</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Resolution</p>\n</td>\n<td>\n<p>Persistent <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">Genital</span> <span class=\"customMeta\" data-dictid=\"bf639c9a2316927771825e1632d9fb\">Arousal</span> Disorder (PGAD)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Confusion assessment test is used in:", "options": [{"label": "A", "text": "Delirium", "correct": true}, {"label": "B", "text": "Dementia", "correct": false}, {"label": "C", "text": "Schizophrenia", "correct": false}, {"label": "D", "text": "Depression", "correct": false}], "correct_answer": "A. Delirium", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Delirium: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In OCD , which of the options below is associated with an unfavorable outcome when treated with exposure and response prevention ?", "options": [{"label": "A", "text": "Pathological doubt", "correct": false}, {"label": "B", "text": "Magical thinking", "correct": false}, {"label": "C", "text": "Hoarding", "correct": true}, {"label": "D", "text": "Contamination obsession", "correct": false}], "correct_answer": "C. Hoarding", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Hoarding\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the fear of heights known as?", "options": [{"label": "A", "text": "Acarophobia", "correct": false}, {"label": "B", "text": "Algophobia", "correct": false}, {"label": "C", "text": "Agoraphobia", "correct": false}, {"label": "D", "text": "Acrophobia", "correct": true}], "correct_answer": "D. Acrophobia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Acroph\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Phobia Name</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Definition</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Arachnophobia</p>\n</td>\n<td>\n<p>Fear of spiders or other arachnids.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Acrophobia</p>\n</td>\n<td>\n<p>Fear of heights or being in high places.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Claustrophobia</p>\n</td>\n<td>\n<p>Fear of confined spaces or being trapped in small areas.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Agoraphobia</p>\n</td>\n<td>\n<p>Fear of situations where escape might be difficult or help may not be available, often associated with open spaces or public areas.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Ophidiophobia</p>\n</td>\n<td>\n<p>Fear of snakes.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Aviophobia</p>\n</td>\n<td>\n<p>Fear of flying or being on airplanes.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Astraphobia</p>\n</td>\n<td>\n<p>Fear of thunder and lightning.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is incorrect regarding MHC molecules?", "options": [{"label": "A", "text": "MHC class II presents peptide antigen to CD4 T cells", "correct": false}, {"label": "B", "text": "The action of MHC II occurs via endocytic pathway", "correct": false}, {"label": "C", "text": "MHC Class II presents endogenous antigens", "correct": true}, {"label": "D", "text": "MHC II is present on antigen presenting cells", "correct": false}], "correct_answer": "C. MHC Class II presents endogenous antigens", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option C - &lt;span class=\"customMeta\" data-dictid=\"99ed7c494c1692777192b0995e73f4\"&gt;MHC&lt;/span&gt; Class II presents &lt;span class=\"customMeta\" data-dictid=\"2a7f0b780c1692777187fe83ec76b1\"&gt;endogenous&lt;/span&gt; antigens:</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:575px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Differences between <span class=\"customMeta\" data-dictid=\"99ed7c494c1692777192b0995e73f4\">MHC</span> Class I and <span class=\"customMeta\" data-dictid=\"99ed7c494c1692777192b0995e73f4\">MHC</span> Class II Molecules</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>MHC Class I</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>MHC Class II</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present on</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>All <span class=\"customMeta\" data-dictid=\"a6f7ad44aa1692777193665a7f5d9a\">nucleated</span> cells (except sperms) and platelets</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Antigen-presenting cells (APCs)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Peptide <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> is</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Presented to CD8 T cells</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Presented to CD4 T cells</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nature of <span class=\"customMeta\" data-dictid=\"53172b32401692777195efbbb6b2e8\">peptide</span> antigen</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Endogenous or <span class=\"customMeta\" data-dictid=\"a621be29da16927771901bc91014d1\">intracellular</span> (viral/tumor antigen)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Exogenous</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Peptide <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> (size)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>8-10 <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acid long</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>13-18 <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acid long</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Antigen presentation pathways</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cytosolic pathway</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Endocytic pathway</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Peptide-binding site</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>alpha1/alpha2 groove</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>alpha1/beta1 groove</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CD4 or CD 8 binding site</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>alpha 3 binds to CD8 molecules on Tc cells</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>beta 2 binds to CD4 on TH cells</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following investigations does not involve the use of antibody labeling?", "options": [{"label": "A", "text": "ELISA", "correct": false}, {"label": "B", "text": "Radioimmunoassay", "correct": false}, {"label": "C", "text": "Immunofluorescence", "correct": false}, {"label": "D", "text": "Hemagglutination Test", "correct": true}], "correct_answer": "D. Hemagglutination Test", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the case of a 3-year-old child with a history of recurrent sinopulmonary infections caused by encapsulated organisms, which of the following is the most probable deficiency?", "options": [{"label": "A", "text": "IgG1", "correct": false}, {"label": "B", "text": "IgG2", "correct": true}, {"label": "C", "text": "IgG3", "correct": false}, {"label": "D", "text": "IgG4", "correct": false}], "correct_answer": "B. IgG2", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - IgG2\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A veterinarian developed an ulcer with a central black eschar over the forearm , as shown in the image. Which of the following is the most probable causative organism?", "options": [{"label": "A", "text": "Pseudomonas aeruginosa", "correct": false}, {"label": "B", "text": "Yersinia pestis", "correct": false}, {"label": "C", "text": "Bacillus anthracis", "correct": true}, {"label": "D", "text": "Francisella tularensis", "correct": false}], "correct_answer": "C. Bacillus anthracis", "question_images": ["https://image.prepladder.com/content/ooxToJZPpJwmCQgWdBme1691505884.png"], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"461ee544961692777182696a650b05\"&gt;Bacillus&lt;/span&gt; Anth\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not used as an immediate test in the screening of urinary tract infections (UTI)?", "options": [{"label": "A", "text": "Pour plate culture", "correct": true}, {"label": "B", "text": "Griess Nitrite test", "correct": false}, {"label": "C", "text": "Leukocyte esterase test", "correct": false}, {"label": "D", "text": "Wet mount examination", "correct": false}], "correct_answer": "A. Pour plate culture", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"65e3810f9316927771965bc770e6d5\"&gt;Pour Plate&lt;/span&gt; Cultu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In which of the following is the disc diffusion method for antibiotic susceptibility testing is applied?", "options": [{"label": "A", "text": "Agar dilution method", "correct": false}, {"label": "B", "text": "Kirby-Bauer method", "correct": true}, {"label": "C", "text": "Broth dilution method", "correct": false}, {"label": "D", "text": "PCR based assay", "correct": false}], "correct_answer": "B. Kirby-Bauer method", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Kirby-Bauer Meth\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the investigation of choice for neurosyphilis?", "options": [{"label": "A", "text": "Venereal disease research laboratory (VDRL) test", "correct": true}, {"label": "B", "text": "FTA-ABS-Fluorescent Treponemal Antibody Absorption test", "correct": false}, {"label": "C", "text": "RPR – Rapid Plasma Reagin test", "correct": false}, {"label": "D", "text": "TPI – Treponema pallidum immobilization test", "correct": false}], "correct_answer": "A. Venereal disease research laboratory (VDRL) test", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"1fabecc13f1692777201555935da4f\"&gt;Venereal&lt;/span&gt; Disease Research Laboratory (VDRL) T\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Non-Specific Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Specific</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Wassermann test (complement <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> technique)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>FTA-ABS (Fluorescent <span class=\"customMeta\" data-dictid=\"c56f7410151692777200183184873a\">treponemal</span> <span class=\"customMeta\" data-dictid=\"9d7a12cab116927771811a0079086d\">antibody</span> absorption</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>KAHN Test (Tube <span class=\"customMeta\" data-dictid=\"cc7b2f64b11692777196c8e39b7611\">precipitation</span> test)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>TPI (Treponema <span class=\"customMeta\" data-dictid=\"21d1ab68e116927771947438d672b8\">pallidum</span> immobilisation)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>VDRL (preferred for neurosyphilis)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>TPHA (Treponema <span class=\"customMeta\" data-dictid=\"21d1ab68e116927771947438d672b8\">pallidum</span> <span class=\"customMeta\" data-dictid=\"41e9ba2129169277718831c5f18f40\">hemagglutination</span> assay</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>TPPA</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>TPPA (Treponema <span class=\"customMeta\" data-dictid=\"21d1ab68e116927771947438d672b8\">pallidum</span> <span class=\"customMeta\" data-dictid=\"d4226a4b2e169277719459bb9339d6\">particulate</span> assay)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Contact based isolation is employed for which of the following diseases?", "options": [{"label": "A", "text": "Diphtheria", "correct": false}, {"label": "B", "text": "MRSA", "correct": true}, {"label": "C", "text": "Mumps", "correct": false}, {"label": "D", "text": "Asthma", "correct": false}], "correct_answer": "B. MRSA", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - MRSA\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An 18 year old female presents with a severe headache and high fever of 101°F. On examination, papilloedema and nuchal rigidity was present. Gram staining of the CSF is shown below. Causative organism is", "options": [{"label": "A", "text": "Haemophilus influenzae type B", "correct": false}, {"label": "B", "text": "Neisseria meningitidis", "correct": true}, {"label": "C", "text": "Stretptococcus pneumoniae", "correct": false}, {"label": "D", "text": "Listeria monocytogenes", "correct": false}], "correct_answer": "B. Neisseria meningitidis", "question_images": ["https://image.prepladder.com/content/NLTYHAhzeq57LuhSXowk1695551301.png"], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"a3acbdadb41692777193612b704230\"&gt;Neisseria&lt;/span&gt; Mening\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the stain used for identifying Cryptococcus ?", "options": [{"label": "A", "text": "Giemsa stain", "correct": false}, {"label": "B", "text": "Ziehl-Nielsen stain", "correct": false}, {"label": "C", "text": "Gram staining", "correct": false}, {"label": "D", "text": "Mucicarmine", "correct": true}], "correct_answer": "D. Mucicarmine", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/6VwujleoR8L66gs005kd1713165488.png"], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"d770979f3d1692777193ff0fdda2e4\"&gt;Mucicarmine&lt;/span&gt; S\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following organisms follow a bird-arthropod–human transmission route?", "options": [{"label": "A", "text": "Malaria", "correct": false}, {"label": "B", "text": "Japanese encephalitis", "correct": true}, {"label": "C", "text": "Plague", "correct": false}, {"label": "D", "text": "Paragonimiasis", "correct": false}], "correct_answer": "B. Japanese encephalitis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Japanese Enceph\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 23-year-old patient with a history of travel to China and the consumption of pickled crab now presents with complains of rusty sputum and cough. What is the most likely causative organisms?", "options": [{"label": "A", "text": "Fasciola buski", "correct": false}, {"label": "B", "text": "Fasciola hepatica", "correct": false}, {"label": "C", "text": "Paragonimus westermani", "correct": true}, {"label": "D", "text": "Schistosoma japonicum", "correct": false}], "correct_answer": "C. Paragonimus westermani", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"36ffd60c4516927771946cb6abb906\"&gt;Paragonimus&lt;/span&gt; W\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Trematode</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Definitive host</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>First <span class=\"customMeta\" data-dictid=\"cf8f491dba169277719075ce2b5594\">intermediate</span> host</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Second <span class=\"customMeta\" data-dictid=\"cf8f491dba169277719075ce2b5594\">intermediate</span> host</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Schistosoma</p>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Human</p>\n</td>\n<td rowspan=\"6\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Snail</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>None</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Paragonimus Wetermani (Pulmonary Fluke)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Crab and Crayfish</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clonorchis sinensis</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fish</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Opisthorchis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fasciola Hepatica (Sheep liver fluke)</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Human and sheep</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fresh <span class=\"customMeta\" data-dictid=\"8528247299169277718135f5551cf6\">Aquatic</span> <span class=\"customMeta\" data-dictid=\"a55b16a09b169277720184a41c82c4\">vegetation</span> (water chestnut)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fasciolopisis Buski</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which type of virus is rubella ?", "options": [{"label": "A", "text": "Flavivirus", "correct": false}, {"label": "B", "text": "Togavirus", "correct": true}, {"label": "C", "text": "Paramyxovirus", "correct": false}, {"label": "D", "text": "Orthomyxovirus", "correct": false}], "correct_answer": "B. Togavirus", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Togaviru\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old female developed pruritic papules with excoriated plaques in the interdigital web spaces. Later the lesion spread to the groin and under the surface of the breasts. The lady gives a history of intense pruritus, which is more severe at night. Given below is the organism responsible for this condition. Identify the wrong statement about the same.", "options": [{"label": "A", "text": "Life history has 4 stages", "correct": false}, {"label": "B", "text": "Larvae have 4 pairs of legs", "correct": false}, {"label": "C", "text": "Classic scabies have a lower mite burden than crusted scabies", "correct": false}, {"label": "D", "text": "Male parasite burrows into the epidermis", "correct": true}], "correct_answer": "D. Male parasite burrows into the epidermis", "question_images": ["https://image.prepladder.com/content/Vl5dLnmIghiL34SBo2gv1713848833.png"], "explanation_images": [], "explanation": "<p>Correct Option D - Male &lt;span class=\"customMeta\" data-dictid=\"a59b97ce831692777194f6c0160f15\"&gt;Parasite&lt;/span&gt; Burrows into the E\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An HIV patient presents with persistent diarrhea. Microscopic examination of the stool reveals oocyst of size 4 to 8 µm as shown below. Identify the causative organism:", "options": [{"label": "A", "text": "Cryptosporidium", "correct": true}, {"label": "B", "text": "Cyclospora", "correct": false}, {"label": "C", "text": "Microspora", "correct": false}, {"label": "D", "text": "Cystoisospora", "correct": false}], "correct_answer": "A. Cryptosporidium", "question_images": ["https://image.prepladder.com/content/NqM3q8c6bK4GOdowQERu1686052569.png"], "explanation_images": ["https://image.prepladder.com/content/rxc523wuTZFlFWg32cr71686052646.png", "https://image.prepladder.com/content/cDSYo72s3AR2T317JeQd1686052625.png"], "explanation": "<p>Correct Option A - Cryptosporidiu\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Cryptosporidium</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Cyclospora</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Isopora</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Size</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4-6 micron</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>8-12 micron</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>24-36 micron</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Shape</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Round</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Round</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Oval</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Aicd Fast (Cold ZN stain)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Variable +/-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient is brought to the hospital, with complaints of seizures and the MRI image of the brain is given below. The disease is most probably caused by?", "options": [{"label": "A", "text": "Cysticercus cellulosae", "correct": true}, {"label": "B", "text": "T. saginata", "correct": false}, {"label": "C", "text": "Cysticercus bovis", "correct": false}, {"label": "D", "text": "T. asiatica", "correct": false}], "correct_answer": "A. Cysticercus cellulosae", "question_images": ["https://image.prepladder.com/content/5WnGf3HZ9ieM8YDTWWUS1714376669.png"], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"cb3026e4ab1692777185af9a4cf2df\"&gt;Cysticercus&lt;/span&gt; cellu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Vaccine that require strain change due to evolving organism is?", "options": [{"label": "A", "text": "Influenza", "correct": true}, {"label": "B", "text": "Diphtheria", "correct": false}, {"label": "C", "text": "Polio", "correct": false}, {"label": "D", "text": "Typhoid", "correct": false}], "correct_answer": "A. Influenza", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Influ\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable diagnosis for a neonate who continues to have unconjugated hyperbilirubinemia after three weeks of birth, with normal liver enzymes, PT/INR, and albumin levels, no evidence of hemolysis on a peripheral blood smear, and a decrease in bilirubin levels following treatment with phenobarbital?", "options": [{"label": "A", "text": "Rotor syndrome", "correct": false}, {"label": "B", "text": "Crigler Najjar type 2", "correct": true}, {"label": "C", "text": "Dubin Johnson syndrome", "correct": false}, {"label": "D", "text": "Crigler Najjar type 1", "correct": false}], "correct_answer": "B. Crigler Najjar type 2", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Crigler-Najjar type 2\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/92kc9WT8JfJuTQHHFHjf1744568573.mp3", "video": ""}, {"text": "Which of the following is not a characteristic of cerebral palsy ?", "options": [{"label": "A", "text": "Hypotonia", "correct": false}, {"label": "B", "text": "Microcephaly", "correct": true}, {"label": "C", "text": "Ataxia", "correct": false}, {"label": "D", "text": "Flaccid paralysis", "correct": false}], "correct_answer": "B. Microcephaly", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Microceph\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is absent in a child with cystic fibrosis?", "options": [{"label": "A", "text": "Sweat chloride test chloride conc of 70mEq/L", "correct": false}, {"label": "B", "text": "Increase immunoreactive trypsinogen level", "correct": false}, {"label": "C", "text": "Hyperkalemia", "correct": true}, {"label": "D", "text": "Contraction alkalosis", "correct": false}], "correct_answer": "C. Hyperkalemia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option C - Hyperk\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/O2CkxvC3wACKoOQ01VKl1745046557.mp3", "video": ""}, {"text": "What is the likely diagnosis for a 9-year-old boy with knee joint swelling, non-blanching rashes (as shown in the picture), haematuria +++ and proteinuria + on urine examination, and normal platelet levels?", "options": [{"label": "A", "text": "Systemic lupus erythematosus (SLE)", "correct": false}, {"label": "B", "text": "Henoch Schoenlein purpura (HSP)", "correct": true}, {"label": "C", "text": "Immune thrombocytopenic purpura (ITP)", "correct": false}, {"label": "D", "text": "Polyarteritis Nodosa (PAN)", "correct": false}], "correct_answer": "B. Henoch Schoenlein purpura (HSP)", "question_images": ["https://image.prepladder.com/content/tPpZXzUMhD6F1EzpoyfN1691507369.png"], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child in your unit is diagnosed with severe acute malnutrition (SAM). According to the WHO criteria, SAM is best defined by:", "options": [{"label": "A", "text": "Weight for age less than -2 SD", "correct": false}, {"label": "B", "text": "Weight for height less than +2 SD", "correct": false}, {"label": "C", "text": "Weight for age less than +3 SD", "correct": false}, {"label": "D", "text": "Weight for height less than -3 SD", "correct": true}], "correct_answer": "D. Weight for height less than -3 SD", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option D: Weight for height less than -3 SD:</p>\n<p><strong>References:</strong></p>\n<ul><li>↳ When assessing and classifying malnutrition in children, the World Health Organization (WHO) uses two primary indicators: Weight for age Weight for height</li><li>↳ Weight for age Weight for height</li><li>↳ Weight for age</li><li>↳ Weight for height</li><li>↳ These indicators are expressed as standard deviation (SD) scores, also known as Z-scores, which compare a child's measurements to the reference population.</li><li>↳ In the case of severe acute malnutrition (SAM), the WHO focuses on the weight for height indicator.</li><li>↳ A weight for height Z-score of less than -3 SD is used to define severe acute malnutrition.</li><li>↳ Incorrect options: Options A, B, and C are incorrect.</li><li>↳ Incorrect options:</li></u\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most frequent symptom of congenital toxoplasmosis ?", "options": [{"label": "A", "text": "Hydrocephalus", "correct": false}, {"label": "B", "text": "Chorioretinitis", "correct": true}, {"label": "C", "text": "Hepatosplenomegaly", "correct": false}, {"label": "D", "text": "Thrombocytopenia", "correct": false}], "correct_answer": "B. Chorioretinitis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Ch\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the molecular defect responsible for liver disease in Dubin-Johnson syndrome ?", "options": [{"label": "A", "text": "ATP7A", "correct": false}, {"label": "B", "text": "ATP7B", "correct": false}, {"label": "C", "text": "ABCC2", "correct": true}, {"label": "D", "text": "SERPINA 1", "correct": false}], "correct_answer": "C. ABCC2", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - ABCC2\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Where would you place the pulse oximeter to measure preductal oxygen saturation in an infant born 3 minutes ago?", "options": [{"label": "A", "text": "Left upper limb", "correct": false}, {"label": "B", "text": "Left lower limb", "correct": false}, {"label": "C", "text": "Right upper limb", "correct": true}, {"label": "D", "text": "Right lower limb", "correct": false}], "correct_answer": "C. Right upper limb", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All of the following are clinical features of necrotizing enterocolitis, except?", "options": [{"label": "A", "text": "Vomiting", "correct": false}, {"label": "B", "text": "Abdominal mass", "correct": false}, {"label": "C", "text": "Erythema of the abdominal wall", "correct": false}, {"label": "D", "text": "Metabolic alkalosis", "correct": true}], "correct_answer": "D. Metabolic alkalosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option D: &lt;span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\"&gt;Metabolic&lt;/span&gt; alk\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the primary reason for HIV infection in a newborn ?", "options": [{"label": "A", "text": "Perinatal transmission", "correct": true}, {"label": "B", "text": "Breast milk", "correct": false}, {"label": "C", "text": "Transplacental", "correct": false}, {"label": "D", "text": "Exchange transfusion with infected blood", "correct": false}], "correct_answer": "A. Perinatal transmission", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - P\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the primary factor for the closure of the ductus arteriosus after birth?", "options": [{"label": "A", "text": "Increase in partial pressure of oxygen (paO2)", "correct": true}, {"label": "B", "text": "Increase in systemic vascular resistance", "correct": false}, {"label": "C", "text": "Increase in circulating prostaglandin levels", "correct": false}, {"label": "D", "text": "Decrease in pulmonary venous resistance", "correct": false}], "correct_answer": "A. Increase in partial pressure of oxygen (paO2)", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option A- Increase in &lt;span class=\"customMeta\" data-dictid=\"a66961ad3a16927771941f00c5ed57\"&gt;partial pressure&lt;/span&gt; of oxygen (paO2).\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which vitamin deficiencies are associated with the presence of cardiac edema and neuropathy?", "options": [{"label": "A", "text": "Biotin", "correct": false}, {"label": "B", "text": "Thiamine", "correct": true}, {"label": "C", "text": "Pyridoxine", "correct": false}, {"label": "D", "text": "Riboflavin", "correct": false}], "correct_answer": "B. Thiamine", "question_images": [], "explanation_images": [], "explanation": "<table>\n<thead>\n<tr>\n<th><strong>Vitamin</strong></th>\n<th><strong>Cardiac Oedema</strong></th>\n<th><strong>Neuropathy</strong></th>\n<th><strong>Other Features</strong></th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td><strong>Thiamine</strong> </td>\n<td>Yes</td>\n<td>Yes</td>\n<td>Wet/dry beriberi</td>\n</tr>\n<tr>\n<td>Biotin</td>\n<td>No</td>\n<td>Rare/mild</td>\n<td>Skin and CNS changes</td>\n</tr>\n<tr>\n<td>Pyridoxine</td>\n<td>No</td>\n<td>Yes</td>\n<td>Seizures, cheilitis, glossitis</td>\n</tr>\n<tr>\n<td>Riboflavin</td>\n<td>No</td>\n<td>No</td>\n<td>Skin, oral, and eye symptoms</td>\n</tr>\n</tbody>\n\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td><strong>Vitamin deficiency</strong></td>\n<td><strong>Clinical manifestations</strong></td>\n</tr>\n<tr>\n<td>B1 (thiamine) deficiency</td>\n<td>\n<ul>\n<li>Beriberi\n\t\t\t\t<ul>\n<li>Wet beriberi</li>\n<li>Dry beriberi</li>\n</ul>\n</li>\n<li>Wernicke-Korsakoff syndrome</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>B2 (riboflavin) deficiency</td>\n<td>Ariboflavinosis</td>\n</tr>\n<tr>\n<td>B3 (niacin) deficiency</td>\n<td>Pellagra</td>\n</tr>\n<tr>\n<td>B5 (pantothenic acid) deficiency</td>\n<td>\n<ul>\n<li>Paresthesia</li>\n<li>Fatigue</li>\n<li>Gastrointestinal disturbances</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>B6 (pyridoxine) deficiency</td>\n<td>\n<ul>\n<li>Peripheral neuropathy</li>\n<li>Glossitis</li>\n<li>Microcytic anemia</li>\n<li>Seizures</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most common reason for liver transplantation in children ?", "options": [{"label": "A", "text": "Alagille syndrome", "correct": false}, {"label": "B", "text": "Biliary atresia", "correct": true}, {"label": "C", "text": "Caroli disease", "correct": false}, {"label": "D", "text": "Hepatocellular carcinoma", "correct": false}], "correct_answer": "B. Biliary atresia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\"&gt;Biliary&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/if4kWt9EMfeQYCq7ADYS1744568894.mp3", "video": ""}, {"text": "While you are evaluating a baby , you show him a bright pink teddy bear that he reaches out to with both hands. What is the earliest age by which this milestone is typically achieved?", "options": [{"label": "A", "text": "4 months", "correct": true}, {"label": "B", "text": "3 months", "correct": false}, {"label": "C", "text": "6 months", "correct": false}, {"label": "D", "text": "7 months", "correct": false}], "correct_answer": "A. 4 months", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - 4 month\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the APGAR score for a newborn baby that is assessed 5 minutes after birth and found to be cyanosed with irregular gasping respiration, a heart rate of 60 beats/min, and minimal response to stimulation?", "options": [{"label": "A", "text": "2", "correct": false}, {"label": "B", "text": "5", "correct": false}, {"label": "C", "text": "3", "correct": false}, {"label": "D", "text": "4", "correct": true}], "correct_answer": "D. 4", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option D\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td><strong>Parameter</strong></td>\n<td><strong>0</strong></td>\n<td><strong>1</strong></td>\n<td><strong>2</strong></td>\n</tr>\n<tr>\n<td><strong>A</strong>ppearance</td>\n<td>Completely blue or pale</td>\n<td>The body is pink, and the extremities are blue</td>\n<td>Completely pink</td>\n</tr>\n<tr>\n<td><strong>P</strong>ulse rate</td>\n<td>Absent</td>\n<td>&lt;100/min</td>\n<td>&gt;100/min</td>\n</tr>\n<tr>\n<td><strong>G</strong>rimace</td>\n<td>No response</td>\n<td>Grimaces only</td>\n<td>Coughs/sneezes</td>\n</tr>\n<tr>\n<td><strong>A</strong>ctivity</td>\n<td>Limp and flaccid</td>\n<td>Some <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> is present</td>\n<td>Flexed <span class=\"customMeta\" data-dictid=\"115643fed616927771961316effc71\">posture</span> and actively moving limbs</td>\n</tr>\n<tr>\n<td><strong>R</strong>espiratory effort</td>\n<td>None</td>\n<td>Slow and irregular</td>\n<td>Normal/strong</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most frequently observed heart defect in congenital rubella syndrome ?", "options": [{"label": "A", "text": "ASD", "correct": false}, {"label": "B", "text": "VSD", "correct": false}, {"label": "C", "text": "PDA", "correct": true}, {"label": "D", "text": "PS", "correct": false}], "correct_answer": "C. PDA", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - PDA\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following choices best characterizes the chest X-ray picture?", "options": [{"label": "A", "text": "Egg on string appearance", "correct": false}, {"label": "B", "text": "Coeur en sabot", "correct": true}, {"label": "C", "text": "Scimitar sign", "correct": false}, {"label": "D", "text": "Snowman sign", "correct": false}], "correct_answer": "B. Coeur en sabot", "question_images": ["https://image.prepladder.com/content/9bKtxJ2WzpqxZtcjbtkE1714387646.png"], "explanation_images": ["https://image.prepladder.com/content/G7b6w3MaKxsBy8ajUEb01714390122.png", "https://image.prepladder.com/content/LFHMPxaEoLE7i8mVbKqF1714390142.png"], "explanation": "<p>Correct option B - Coeur &lt;span class=\"customMeta\" data-dictid=\"fc695a78ad16927771878f69871998\"&gt;en&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following drugs cause carcinoma bladder ?", "options": [{"label": "A", "text": "Cyclophosphamide", "correct": true}, {"label": "B", "text": "Cisplatin", "correct": false}, {"label": "C", "text": "Taxane", "correct": false}, {"label": "D", "text": "Tamoxifen", "correct": false}], "correct_answer": "A. Cyclophosphamide", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Cyclophosph\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Transitional cell carcinoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Squamous cell carcinoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1. Smoking</p>\n<p>2. Drugs</p>\n<ul>\n<li>\n<p>Phenacetin</p>\n</li>\n<li>\n<p>Chlornaphazine</p>\n</li>\n<li>\n<p>Cyclophosphamide</p>\n</li>\n</ul>\n<p>3. Exposure of</p>\n<ul>\n<li>\n<p>Benzidine</p>\n</li>\n<li>\n<p>Hydrocarbon</p>\n</li>\n<li>\n<p>Aniline</p>\n</li>\n<li>\n<p>Acrolein</p>\n</li>\n<li>\n<p>Beta-naphthylamine</p>\n</li>\n</ul>\n<p>4. Printing, Dyeing, Rubber, Leather, Automobile &amp; <span class=\"customMeta\" data-dictid=\"784bd236b21692777195bf9eb52a33\">Petroleum</span> industries</p>\n<p>5. <span class=\"customMeta\" data-dictid=\"26cdc047771692777198466c58cdc6\">Schistosomiasis</span> (SSC &gt; TCC)</p>\n<p>6. <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">Pelvic</span> irradiation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1. Schistosomiasis</p>\n<p>2. Chronic Inflammation</p>\n<ul>\n<li>\n<p>Bladder stone</p>\n</li>\n<li>\n<p>Bladder diverticulum</p>\n</li>\n<li>\n<p>Prolonged catheterization</p>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The most common site of branchial cyst is___ .", "options": [{"label": "A", "text": "Junction of upper and middle third of the sternomastoid muscle", "correct": true}, {"label": "B", "text": "Junction of middle and lower third of the sternomastoid muscle", "correct": false}, {"label": "C", "text": "Middle of the sternomastoid muscle", "correct": false}, {"label": "D", "text": "Between the two heads of the sternomastoid muscle", "correct": false}], "correct_answer": "A. Junction of upper and middle third of the sternomastoid muscle", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/NN3PvhyDKPCBaCdf0iJW1714479467.png"], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\"&gt;Junction&lt;/span&gt; of upper and middle third of the &lt;span class=\"customMeta\" data-dictid=\"d8cde9fb6a16927771990f620123da\"&gt;sternomastoid&lt;/span&gt; muscle:</p>\n<p><strong>Educational Objective:</strong></p>\n<ul><li>➤ Options B, C &amp; D are incorrect; refer to the explanation of the correct answer and learning objective.</li><li>➤ Options B, C &amp; D are incorrect; refer to the explanation of the correct answer and learning objective.</li><li>➤ Options B, C &amp; D</li></u\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Dohlman's procedure is for:", "options": [{"label": "A", "text": "Meckel's diverticulum", "correct": false}, {"label": "B", "text": "Zenker's diverticulum", "correct": true}, {"label": "C", "text": "Bochadlek hernia", "correct": false}, {"label": "D", "text": "Menetrier's disease", "correct": false}], "correct_answer": "B. Zenker's diverticulum", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Zenker's diverticulu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Parathyroid gland post-surgery is commonly transferred to?", "options": [{"label": "A", "text": "Triceps", "correct": false}, {"label": "B", "text": "Biceps", "correct": false}, {"label": "C", "text": "Sartorius", "correct": false}, {"label": "D", "text": "Brachioradialis", "correct": true}], "correct_answer": "D. Brachioradialis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Brach\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is false regarding rectal carcinoma ?", "options": [{"label": "A", "text": "Hartmann's operation is done in elderly debilitated patients", "correct": false}, {"label": "B", "text": "Adenocarcinoma is a rare variant of rectal carcinoma", "correct": true}, {"label": "C", "text": "Early morning spurious diarrhoea and tenesmus can occur", "correct": false}, {"label": "D", "text": "Growth confined to the rectal mucosa is stage A of modified Duke's staging", "correct": false}], "correct_answer": "B. Adenocarcinoma is a rare variant of rectal carcinoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Adenocarcinoma is a rare &lt;span class=\"customMeta\" data-dictid=\"0efdcdc9e01692777201003c81c85a\"&gt;variant&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A gasless abdomen is seen in?", "options": [{"label": "A", "text": "Ulcerative colitis", "correct": false}, {"label": "B", "text": "Intussusception", "correct": false}, {"label": "C", "text": "Acute pancreatitis", "correct": true}, {"label": "D", "text": "Crohn's disease", "correct": false}], "correct_answer": "C. Acute pancreatitis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Acu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Gall stone chemistry most commonly seen amongst the following is:", "options": [{"label": "A", "text": "Crystalline cholesterol monohydrate", "correct": true}, {"label": "B", "text": "Crystalline cholesterol dihydrate", "correct": false}, {"label": "C", "text": "Amorphous cholesterol dihydrate", "correct": false}, {"label": "D", "text": "Amorphous cholesterol monohydrate", "correct": false}], "correct_answer": "A. Crystalline cholesterol monohydrate", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What does the presence of serpiginous ulcers during esophageal endoscopy in a patient indicate in terms of diagnosis?", "options": [{"label": "A", "text": "CMV esophagitis", "correct": true}, {"label": "B", "text": "Candida esophagitis", "correct": false}, {"label": "C", "text": "Herpetic esophagitis", "correct": false}, {"label": "D", "text": "Radiation esophagitis", "correct": false}], "correct_answer": "A. CMV esophagitis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - CMV esophag\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which section of the Indian Penal Code (IPC) is associated with the penalization of perjury ?", "options": [{"label": "A", "text": "191", "correct": false}, {"label": "B", "text": "192", "correct": false}, {"label": "C", "text": "193", "correct": true}, {"label": "D", "text": "197", "correct": false}], "correct_answer": "C. 193", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Section 193 of the Indian Penal Code (IPC)\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Section</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Offense/Topic</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Section 191</p>\n</td>\n<td>\n<p>Giving false evidence</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Section 192</p>\n</td>\n<td>\n<p>Fabricating false evidence</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Section 193</p>\n</td>\n<td>\n<p>Punishment for false evidence</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Section 196</p>\n</td>\n<td>\n<p>Using evidence known to be false</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Section 197</p>\n</td>\n<td>\n<p>Issuing or <span class=\"customMeta\" data-dictid=\"021d2f43da169277719870c7638655\">signing</span> false certificate</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Section 201</p>\n</td>\n<td>\n<p>Causing disappearance of evidence</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Gastric lavage can be performed in case of which of the following poisoning ?", "options": [{"label": "A", "text": "Sulphuric acid", "correct": false}, {"label": "B", "text": "Strychnine", "correct": false}, {"label": "C", "text": "Carbolic acid", "correct": true}, {"label": "D", "text": "Kerosene oil", "correct": false}], "correct_answer": "C. Carbolic acid", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - C\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Frotteurism is characterized as _____________:", "options": [{"label": "A", "text": "Obtaining sexual pleasure by wearing clothes of opposite sex", "correct": false}, {"label": "B", "text": "Desire to seek surgery to become member of opposite sex", "correct": false}, {"label": "C", "text": "Sexual gratification by rubbing his private parts against another person", "correct": true}, {"label": "D", "text": "Exposure of one’s genitals to an unsuspecting stranger", "correct": false}], "correct_answer": "C. Sexual gratification by rubbing his private parts against another person", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Sexual gratification by &lt;span class=\"customMeta\" data-dictid=\"97ae59957c1692777197359406f6f4\"&gt;rubbing&lt;/span&gt; his private parts against anoth\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Medical Term</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Explanation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Transvestism or Cross-dressing</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Refers to obtaining sexual pleasure or gratification by wearing clothes typically associated with the opposite sex.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gender <span class=\"customMeta\" data-dictid=\"08289506491692777186a3dceb93ad\">dysphoria</span> or <span class=\"customMeta\" data-dictid=\"ef4efed5d61692777188f931d3254e\">Gender identity</span> disorder</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Describes the <span class=\"customMeta\" data-dictid=\"afafb9026e1692777186e3dd168fa8\">distress</span> or discomfort an individual may experience due to a <span class=\"customMeta\" data-dictid=\"59dd49e97716927771865a831bfec9\">discrepancy</span> between their assigned gender and gender identity. Surgery may be sought as part of treatment.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Frotteurism</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involves sexual gratification derived from <span class=\"customMeta\" data-dictid=\"97ae59957c1692777197359406f6f4\">rubbing</span> one's <span class=\"customMeta\" data-dictid=\"1588e9cd72169277718891982853b4\">genitals</span> against another person without their consent.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Exhibitionism</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involves exposing one's <span class=\"customMeta\" data-dictid=\"1588e9cd72169277718891982853b4\">genitals</span> to unsuspecting individuals for sexual <span class=\"customMeta\" data-dictid=\"bf639c9a2316927771825e1632d9fb\">arousal</span> or gratification.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identical twins have similarities in all of the following except ?", "options": [{"label": "A", "text": "Blood group", "correct": false}, {"label": "B", "text": "DNA fingerprinting", "correct": false}, {"label": "C", "text": "Fingerprint pattern", "correct": true}, {"label": "D", "text": "Iris color", "correct": false}], "correct_answer": "C. Fingerprint pattern", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"d8465bf7bc1692777202d6b3e6c8bd\"&gt;Fingerprint&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements accurately describes battered baby syndrome?", "options": [{"label": "A", "text": "Skin lesions and bruises of various ages are seen on the body", "correct": true}, {"label": "B", "text": "It occurs due to the tendency of a child to fall repeatedly", "correct": false}, {"label": "C", "text": "Multiple stab wounds are seen", "correct": false}, {"label": "D", "text": "The syndrome is a result of firearm injuries", "correct": false}], "correct_answer": "A. Skin lesions and bruises of various ages are seen on the body", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following tests relies on the principle that the suspect's reaction is influenced by their prior knowledge of the events or activity?", "options": [{"label": "A", "text": "Truth Serum", "correct": false}, {"label": "B", "text": "Polygraph", "correct": false}, {"label": "C", "text": "Brain Mapping", "correct": true}, {"label": "D", "text": "Hypnosis", "correct": false}], "correct_answer": "C. Brain Mapping", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Option</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Explanation</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>1</p>\n</td>\n<td>\n<p>Brain Mapping: Based on the principle that prior knowledge of events or activity can influence brain activity. It measures <span class=\"customMeta\" data-dictid=\"b00388be25169277719369b3ab059f\">neural</span> activity to detect deception or hidden information.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>2</p>\n</td>\n<td>\n<p>Truth Serum: Not a widely accepted method. The reliability and effectiveness in obtaining accurate information are debated. Not considered a reliable method of determining truth.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>3</p>\n</td>\n<td>\n<p>Polygraph: Measures <span class=\"customMeta\" data-dictid=\"6c2c85ae6b16927771950809419a59\">physiological</span> changes in the body to detect deception. Controversial accuracy and reliability. Results not considered <span class=\"customMeta\" data-dictid=\"32b854324a1692777185c6c79fdc99\">definitive</span> evidence of deception.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>4</p>\n</td>\n<td>\n<p>Hypnosis: Involves an altered state of consciousness. Reliability and accuracy in eliciting truthful information are debated. Not widely accepted as a <span class=\"customMeta\" data-dictid=\"32b854324a1692777185c6c79fdc99\">definitive</span> method for determining truth</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In alleged history of gunshot injury , there is burning, blackening, tattooing around the wound . The injury is:", "options": [{"label": "A", "text": "Close shot entry wound", "correct": true}, {"label": "B", "text": "Close shot exit wound", "correct": false}, {"label": "C", "text": "Distant shot entry wound", "correct": false}, {"label": "D", "text": "Distant shot exit wound", "correct": false}], "correct_answer": "A. Close shot entry wound", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Close shot entry wou\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Gunshot Injury Range</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Proximity of Firearm to Body</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Characteristics</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\">Contact Range</p>\n</td>\n<td>\n<p style=\"text-align: center;\">Muzzle in direct contact</p>\n</td>\n<td>\n<ul>\n<li>\n<p>Burning, blackening, and <span class=\"customMeta\" data-dictid=\"16777b606e16927772006cbb6869ce\">tattooing</span> around entry wound</p>\n</li>\n<li>\n<p>Irregular or <span class=\"customMeta\" data-dictid=\"41b4e6c32f169277719986f77fbe28\">stellate</span> appearance for exit wounds</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\">Close Range</p>\n</td>\n<td>\n<p style=\"text-align: center;\">Muzzle in close proximity</p>\n</td>\n<td>\n<ul>\n<li>\n<p>Burning, blackening, and <span class=\"customMeta\" data-dictid=\"16777b606e16927772006cbb6869ce\">tattooing</span> around entry wound</p>\n</li>\n<li>\n<p>Exit wounds may exhibit <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> or <span class=\"customMeta\" data-dictid=\"41b4e6c32f169277719986f77fbe28\">stellate</span> appearance</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\">Near Range</p>\n</td>\n<td>\n<p style=\"text-align: center;\">Short distance from body</p>\n</td>\n<td>\n<ul>\n<li>\n<p>Less pronounced effects of burning, blackening, and tattooing</p>\n</li>\n<li>\n<p>Entry and exit wounds may show some characteristics of contact or close-range injuries</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\">Distant Range</p>\n</td>\n<td>\n<p style=\"text-align: center;\">Significant distance</p>\n</td>\n<td>\n<ul>\n<li>\n<p>Absent or minimal effects of burning, blackening, and tattooing</p>\n</li>\n<li>\n<p>Smaller, <span class=\"customMeta\" data-dictid=\"0919f0017e1692777184ac3748841f\">circular</span> or oval-shaped entry and exit wounds</p>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Rigor mortis occurs first in:", "options": [{"label": "A", "text": "Eyelids", "correct": false}, {"label": "B", "text": "Intestines", "correct": false}, {"label": "C", "text": "Myocardium", "correct": true}, {"label": "D", "text": "Neck", "correct": false}], "correct_answer": "C. Myocardium", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Myocardiu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following joint is the best predictor of age of 16 to 17 years by X-ray ?", "options": [{"label": "A", "text": "Knee", "correct": false}, {"label": "B", "text": "Elbow", "correct": false}, {"label": "C", "text": "Hip", "correct": false}, {"label": "D", "text": "Ankle", "correct": true}], "correct_answer": "D. Ankle", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Ank\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following acts as a physiological antidote to scorpion venom ?", "options": [{"label": "A", "text": "Physostigmine", "correct": false}, {"label": "B", "text": "Norepinephrine", "correct": false}, {"label": "C", "text": "Prazosin", "correct": true}, {"label": "D", "text": "Atropine", "correct": false}], "correct_answer": "C. Prazosin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - P\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Mechanism</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Explanation</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Scorpion Venom</strong></p>\n</td>\n<td>\n<p>Scorpion <span class=\"customMeta\" data-dictid=\"ce053080da169277720142dbefddb2\">venom</span> contains various neurotoxins that stimulate the <span class=\"customMeta\" data-dictid=\"5731c5431416927771999e54e2563b\">sympathetic</span> nervous system, leading to increased release of <span class=\"customMeta\" data-dictid=\"155371e9941692777193b48666ce0a\">norepinephrine</span> (a neurotransmitter) and subsequent <span class=\"customMeta\" data-dictid=\"ba6b77f29316927771807350f86ce2\">activation</span> of alpha-1 <span class=\"customMeta\" data-dictid=\"0132a02ec31692777180a840765aff\">adrenergic</span> receptors.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Prazosin</strong></p>\n</td>\n<td>\n<p>Prazosin is an alpha-1 <span class=\"customMeta\" data-dictid=\"0132a02ec31692777180a840765aff\">adrenergic</span> <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antagonist, meaning it blocks the binding of <span class=\"customMeta\" data-dictid=\"155371e9941692777193b48666ce0a\">norepinephrine</span> to these receptors. By inhibiting the <span class=\"customMeta\" data-dictid=\"ba6b77f29316927771807350f86ce2\">activation</span> of alpha-1 <span class=\"customMeta\" data-dictid=\"0132a02ec31692777180a840765aff\">adrenergic</span> receptors, prazosin counteracts the <span class=\"customMeta\" data-dictid=\"3f0b42b17016927772014c586d44b7\">vasoconstriction</span> and other <span class=\"customMeta\" data-dictid=\"5731c5431416927771999e54e2563b\">sympathetic</span> responses caused by excessive <span class=\"customMeta\" data-dictid=\"5731c5431416927771999e54e2563b\">sympathetic</span> <span class=\"customMeta\" data-dictid=\"7f3792072b1692777199fd8e2c4f59\">stimulation</span> from <span class=\"customMeta\" data-dictid=\"4fb3e709b616927771986543dd5247\">scorpion</span> venom.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Effect</strong></p>\n</td>\n<td>\n<p>The <span class=\"customMeta\" data-dictid=\"70d039f1401692777183bb2f23a21a\">blockade</span> of alpha-1 <span class=\"customMeta\" data-dictid=\"0132a02ec31692777180a840765aff\">adrenergic</span> receptors by prazosin results in <span class=\"customMeta\" data-dictid=\"7aa9f8d34616927772018c11493bbc\">vasodilation</span> (relaxation of blood vessels), which helps to lower blood pressure.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is commonly used for preservation of viscera in toxicology autopsy ?", "options": [{"label": "A", "text": "Glycerin", "correct": false}, {"label": "B", "text": "Rectified spirit", "correct": false}, {"label": "C", "text": "Formalin", "correct": false}, {"label": "D", "text": "Saturated salt solution", "correct": true}], "correct_answer": "D. Saturated salt solution", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "According to myogenic hypothesis of renal autoregulation the afferent arterioles contract in response?", "options": [{"label": "A", "text": "NO", "correct": false}, {"label": "B", "text": "Noradrenaline", "correct": false}, {"label": "C", "text": "Calcium", "correct": true}, {"label": "D", "text": "Adenosine", "correct": false}], "correct_answer": "C. Calcium", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Calciu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a characteristic of decerebrate rigidity according to the Herrington classification ?", "options": [{"label": "A", "text": "Rigidity occurs in all the muscles of the body", "correct": true}, {"label": "B", "text": "Increase in the rate of discharge of the γ efferent neuron", "correct": false}, {"label": "C", "text": "Increased excitability of the motor neuron pool", "correct": false}, {"label": "D", "text": "Mid Collicular lesion can lead to decerebrate rigidity", "correct": false}], "correct_answer": "A. Rigidity occurs in all the muscles of the body", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"9ab07bba3016927771976de44bf865\"&gt;Rigidity&lt;/span&gt; occurs in all the muscles of th\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the options accurately describes decorticate rigidity ?", "options": [{"label": "A", "text": "It is produced by the removal of cerebral cortex and basal ganglia.", "correct": false}, {"label": "B", "text": "Flexion of lower limbs and extension of upper limbs occurs.", "correct": false}, {"label": "C", "text": "Rigidity is pronounced.", "correct": false}, {"label": "D", "text": "It is characterized by flexion of upper limbs and extension of lower limbs.", "correct": true}], "correct_answer": "D. It is characterized by flexion of upper limbs and extension of lower limbs.", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - It is characterized by &lt;span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\"&gt;flexion&lt;/span&gt; of upper limbs and extension of lower limbs: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What would be the duration for preserving red blood cells (RBCs) using Acid Citrate Dextrose (ACD) for storage, when phosphate is added alone and when adenine and phosphate are added together to ACD?", "options": [{"label": "A", "text": "35 days and 42 days", "correct": false}, {"label": "B", "text": "21 days and 35 days", "correct": true}, {"label": "C", "text": "28 days and 45 days", "correct": false}, {"label": "D", "text": "35 days and 28 days", "correct": false}], "correct_answer": "B. 21 days and 35 days", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Preservative</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Storage Period</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Citrate <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">Phosphate</span> <span class=\"customMeta\" data-dictid=\"baf8b019b01692777186c856f83721\">Dextrose</span> (CPD)</p>\n<p>Acid <span class=\"customMeta\" data-dictid=\"3569209ba41692777184f88db9316d\">Citrate</span> <span class=\"customMeta\" data-dictid=\"baf8b019b01692777186c856f83721\">Dextrose</span> (ACD)</p>\n<p>Acid <span class=\"customMeta\" data-dictid=\"3569209ba41692777184f88db9316d\">Citrate</span> <span class=\"customMeta\" data-dictid=\"baf8b019b01692777186c856f83721\">Dextrose</span> Formula A (ACD-A)</p>\n</td>\n<td>\n<p>Up to 21 days</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Citrate <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">Phosphate</span> <span class=\"customMeta\" data-dictid=\"baf8b019b01692777186c856f83721\">Dextrose</span> <span class=\"customMeta\" data-dictid=\"701cef29c216927771801e7d1a7c0f\">Adenine</span> (CPDA-1)</p>\n<p>Citrate <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">Phosphate</span> <span class=\"customMeta\" data-dictid=\"baf8b019b01692777186c856f83721\">Dextrose</span> <span class=\"customMeta\" data-dictid=\"701cef29c216927771801e7d1a7c0f\">Adenine</span> (CP2D)</p>\n</td>\n<td>\n<p>Up to 35 days</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Acid <span class=\"customMeta\" data-dictid=\"3569209ba41692777184f88db9316d\">Citrate</span> <span class=\"customMeta\" data-dictid=\"baf8b019b01692777186c856f83721\">Dextrose</span> <span class=\"customMeta\" data-dictid=\"701cef29c216927771801e7d1a7c0f\">Adenine</span> (ACDA)</p>\n</td>\n<td>\n<p>Up to 35 days</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Additive Solution 1 (AS-1)</p>\n<p>Additive Solution 2 (AS-2)</p>\n</td>\n<td>\n<p>Up to 42 days</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Optisol</p>\n</td>\n<td>\n<p>Up to 7 days</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Functional residua l capacity is:", "options": [{"label": "A", "text": "Volume expired after normal inspiration", "correct": false}, {"label": "B", "text": "Volume that remains after forced expiration", "correct": false}, {"label": "C", "text": "Expiratory reserve volume + residual volume", "correct": true}, {"label": "D", "text": "Tidal volume + inspiratory reserve volume", "correct": false}], "correct_answer": "C. Expiratory reserve volume + residual volume", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Expiratory reserve volume + &lt;span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\"&gt;residual&lt;/span&gt; volume: \n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Lung Volume/Capacity</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Typical Value (in adults)</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Tidal Volume (TV)</p>\n</td>\n<td>\n<p>Volume of air inhaled or exhaled during normal breathing</p>\n</td>\n<td>\n<p>500 mL</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Inspiratory Reserve Volume (IRV)</p>\n</td>\n<td>\n<p>Additional volume of air that can be inhaled after a normal <span class=\"customMeta\" data-dictid=\"9de1765e531692777200d737a38c98\">tidal</span> inspiration</p>\n</td>\n<td>\n<p>2,500-3,000 mL</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Expiratory Reserve Volume (ERV)</p>\n</td>\n<td>\n<p>Additional volume of air that can be exhaled after a normal <span class=\"customMeta\" data-dictid=\"9de1765e531692777200d737a38c98\">tidal</span> expiration</p>\n</td>\n<td>\n<p>1,000-1,200 mL</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Residual Volume (RV)</p>\n</td>\n<td>\n<p>Volume of air remaining in the lungs after <span class=\"customMeta\" data-dictid=\"c678bddb1d1692777192d2ee1ebd92\">maximal</span> expiration</p>\n</td>\n<td>\n<p>1,200-1,300 mL</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Total Lung Capacity (TLC)</p>\n</td>\n<td>\n<p>Maximum volume of air the lungs can hold, including inspiratory reserve volume, <span class=\"customMeta\" data-dictid=\"9de1765e531692777200d737a38c98\">tidal</span> volume, <span class=\"customMeta\" data-dictid=\"632c0c215816927771878b6e818a11\">expiratory</span> reserve volume, and <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">residual</span> volume</p>\n</td>\n<td>\n<p>5,000-6,000 mL</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Vital Capacity (VC)</p>\n</td>\n<td>\n<p>Maximum volume of air that can be exhaled after a <span class=\"customMeta\" data-dictid=\"c678bddb1d1692777192d2ee1ebd92\">maximal</span> inspiration, including inspiratory reserve volume, <span class=\"customMeta\" data-dictid=\"9de1765e531692777200d737a38c98\">tidal</span> volume, and <span class=\"customMeta\" data-dictid=\"632c0c215816927771878b6e818a11\">expiratory</span> reserve volume</p>\n</td>\n<td>\n<p>4,500-5,000 mL</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Functional <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">Residual</span> Capacity (FRC)</p>\n</td>\n<td>\n<p>Volume of air remaining in the lungs after a normal <span class=\"customMeta\" data-dictid=\"9de1765e531692777200d737a38c98\">tidal</span> expiration, including <span class=\"customMeta\" data-dictid=\"632c0c215816927771878b6e818a11\">expiratory</span> reserve volume and <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">residual</span> volume</p>\n</td>\n<td>\n<p>2,400-2,800 mL</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Inspiratory Capacity (IC)</p>\n</td>\n<td>\n<p>Maximum volume of air that can be inhaled after a normal <span class=\"customMeta\" data-dictid=\"9de1765e531692777200d737a38c98\">tidal</span> expiration, including <span class=\"customMeta\" data-dictid=\"9de1765e531692777200d737a38c98\">tidal</span> volume and inspiratory reserve volume</p>\n</td>\n<td>\n<p>3,500-3,800 mL</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a dietary fiber ?", "options": [{"label": "A", "text": "Cellulose", "correct": false}, {"label": "B", "text": "Inulin", "correct": false}, {"label": "C", "text": "Pectin", "correct": false}, {"label": "D", "text": "Gums", "correct": true}], "correct_answer": "D. Gums", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D-Gu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the effect of a lesion in the medial lemniscus at the level of the pons ?", "options": [{"label": "A", "text": "Pain and temperature loss in the same side", "correct": false}, {"label": "B", "text": "Pain and temperature loss in the opposite side", "correct": false}, {"label": "C", "text": "Loss of tactile and proprioception on the same side", "correct": false}, {"label": "D", "text": "Loss of tactile and proprioception on the opposite side", "correct": true}], "correct_answer": "D. Loss of tactile and proprioception on the opposite side", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/mD4EEy7MZ9we5FECsniB1717647496.png"], "explanation": "<p>Correct Option D - Loss of &lt;span class=\"customMeta\" data-dictid=\"ff110f2cb71692777200a3483aa670\"&gt;tactile&lt;/span&gt; and &lt;span class=\"customMeta\" data-dictid=\"dfc9bfb34d1692777196105fe5da3c\"&gt;proprioception&lt;/span&gt; on th\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which specific neurotransmitter is accountable for causing dilation of the small intestine in a forward direction?", "options": [{"label": "A", "text": "VIP", "correct": true}, {"label": "B", "text": "Acetylcholine", "correct": false}, {"label": "C", "text": "Substance P", "correct": false}, {"label": "D", "text": "Serotonin", "correct": false}], "correct_answer": "A. VIP", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which reflex is responsible for tachycardia when the right atrium is distended?", "options": [{"label": "A", "text": "J reflex", "correct": false}, {"label": "B", "text": "Cushing reflex", "correct": false}, {"label": "C", "text": "Bezoid jarisch reflex", "correct": false}, {"label": "D", "text": "Bainbridge reflex", "correct": true}], "correct_answer": "D. Bainbridge reflex", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The primary source of testosterone production is primarily contributed by _________.", "options": [{"label": "A", "text": "Leydig cells", "correct": true}, {"label": "B", "text": "Sertoli cells", "correct": false}, {"label": "C", "text": "Seminiferous tubules", "correct": false}, {"label": "D", "text": "Epididymis", "correct": false}], "correct_answer": "A. Leydig cells", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Cell Type</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Location</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Function</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Leydig cells</p>\n</td>\n<td>\n<p>Interstitial</p>\n</td>\n<td>\n<p>Production and <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> of testosterone</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Sertoli cells</p>\n</td>\n<td>\n<p>Seminiferous tubules</p>\n</td>\n<td>\n<p>Support and nourishment of developing <span class=\"customMeta\" data-dictid=\"8dc15ef09e1692777198320917e46b\">sperm</span> cells, <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> of hormones, creation of blood-testis barrier</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Germ cells</p>\n</td>\n<td>\n<p>Seminiferous tubules</p>\n</td>\n<td>\n<p>Sperm cell production and maturation</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Spermatogonia</p>\n</td>\n<td>\n<p>Seminiferous tubules</p>\n</td>\n<td>\n<p>Self-renewal and <span class=\"customMeta\" data-dictid=\"55a682d72e16927771865bb4855ba3\">differentiation</span> into <span class=\"customMeta\" data-dictid=\"8dc15ef09e1692777198320917e46b\">sperm</span> cells</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Spermatozoa</p>\n</td>\n<td>\n<p>Seminiferous tubules</p>\n</td>\n<td>\n<p>Mature <span class=\"customMeta\" data-dictid=\"8dc15ef09e1692777198320917e46b\">sperm</span> cells capable of fertilization</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Endothelial cells</p>\n</td>\n<td>\n<p>Blood vessels within testis</p>\n</td>\n<td>\n<p>Formation of blood vessels and transport of nutrients</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the cause of the appearance observed in IVP?", "options": [{"label": "A", "text": "Horseshoe kidney", "correct": false}, {"label": "B", "text": "Ureterococele", "correct": true}, {"label": "C", "text": "Bladder tumor", "correct": false}, {"label": "D", "text": "Posterior urethral valve", "correct": false}], "correct_answer": "B. Ureterococele", "question_images": ["https://image.prepladder.com/content/p3ORuOmrg7Bir083t6yk1697525542.png"], "explanation_images": [], "explanation": "<p>Correct Option b: Ureterococele.\n<table>\n<tbody>\n<tr>\n<td>Definition</td>\n<td>Ureterocele is a <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> or <span class=\"customMeta\" data-dictid=\"0f0b2969921692777180de24f0b0c0\">acquired</span> condition where the <span class=\"customMeta\" data-dictid=\"8cde7563da1692777201fca2b1f090\">ureter</span> (the tube that carries <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> from the <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> to the bladder) balloons at its lower end, forming a pouch-like structure.</td>\n</tr>\n<tr>\n<td>Types</td>\n<td>Primary (congenital) and secondary (acquired) ureteroceles. Primary ureteroceles are typically present from birth and occur as a result of <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> embryonic development. Secondary ureteroceles may develop later in life due to various factors.</td>\n</tr>\n<tr>\n<td>Location</td>\n<td>Most commonly found in the <span class=\"customMeta\" data-dictid=\"8cde7563da1692777201fca2b1f090\">ureter</span> that drains one kidney, but <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> ureteroceles (affecting both kidneys) can occur in rare cases.</td>\n</tr>\n<tr>\n<td>Presentation</td>\n<td>Ureteroceles can be <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> or cause a range of symptoms, including <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infections (UTIs), <span class=\"customMeta\" data-dictid=\"316968b3e116927772021379938005\">flank</span> pain, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> discomfort, <span class=\"customMeta\" data-dictid=\"660645b0c91692777188bbdf3fedff\">hematuria</span> (blood in the urine), and difficulty in <span class=\"customMeta\" data-dictid=\"397f16a7a71692777187ffffefa7e6\">emptying</span> the bladder.</td>\n</tr>\n<tr>\n<td>Diagnosis</td>\n<td>Typically diagnosed through <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> studies such as ultrasound, <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> <span class=\"customMeta\" data-dictid=\"b28907b0441692777196ab31880644\">pyelogram</span> (IVP), CT scan, or cystoscopy.</td>\n</tr>\n<tr>\n<td>Treatment</td>\n<td>Treatment depends on the severity of symptoms and complications. Options may include antibiotics for UTIs, <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> removal of the ureterocele, <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">endoscopic</span> procedures, and in some cases, surgery to reconstruct the <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> tract.</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the role of tubuloglomerular feedback?", "options": [{"label": "A", "text": "Regulate GFR", "correct": true}, {"label": "B", "text": "Decrease plasma sodium", "correct": false}, {"label": "C", "text": "Increase plasma volume", "correct": false}, {"label": "D", "text": "Decrease tubular secretion", "correct": false}], "correct_answer": "A. Regulate GFR", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Regulate GFR\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the blood group determined by the agglutination test depicted below?", "options": [{"label": "A", "text": "B positive", "correct": false}, {"label": "B", "text": "A positive", "correct": false}, {"label": "C", "text": "O positive", "correct": true}, {"label": "D", "text": "AB positive", "correct": false}], "correct_answer": "C. O positive", "question_images": ["https://image.prepladder.com/content/GLzJNrExrxZBDczpEUBK1691507708.png"], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Blood Group</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Antigens Present on Red Blood Cells</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Antibodies Present in Plasma</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>A positive</p>\n</td>\n<td>\n<p>A antigen</p>\n</td>\n<td>\n<p>Anti-B antibodies</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>B positive</p>\n</td>\n<td>\n<p>B antigen</p>\n</td>\n<td>\n<p>Anti-A antibodies</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>AB negative</p>\n</td>\n<td>\n<p>A and B antigens</p>\n</td>\n<td>\n<p>None</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>O negative</p>\n</td>\n<td>\n<p>None</p>\n</td>\n<td>\n<p>Anti-A and Anti-B antibodies</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During forceful expiration, which type of neurons primarily exhibit increased firing ?", "options": [{"label": "A", "text": "Dorsal group of neurons", "correct": false}, {"label": "B", "text": "Caudal Ventral group of neurons", "correct": true}, {"label": "C", "text": "Pneumotaxic center", "correct": false}, {"label": "D", "text": "Apneustic center", "correct": false}], "correct_answer": "B. Caudal Ventral group of neurons", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"a49829e8ef1692777183bc64f40412\"&gt;Caudal&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"9ccb2fd2f31692777201e231bfda74\"&gt;Ventral&lt;/span&gt; group of neu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Through which aquaporin channel does ADH act?", "options": [{"label": "A", "text": "1", "correct": false}, {"label": "B", "text": "2", "correct": true}, {"label": "C", "text": "3", "correct": false}, {"label": "D", "text": "4", "correct": false}], "correct_answer": "B. 2", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/JeBKubloML4VHhjsu5Eg1717656035.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following options has the slowest conduction velocity ?", "options": [{"label": "A", "text": "Postganglionic sympathetic fibers", "correct": true}, {"label": "B", "text": "Somatic motor fibers", "correct": false}, {"label": "C", "text": "Preganglionic autonomic fibers", "correct": false}, {"label": "D", "text": "Touch and pressure fibers", "correct": false}], "correct_answer": "A. Postganglionic sympathetic fibers", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"28ec2061691692777196c06b1c0fd4\"&gt;Postganglionic&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"5731c5431416927771999e54e2563b\"&gt;sympathetic&lt;/span&g\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Myelination</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Fiber type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Numerical <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">classification</span> (By Lloyd and Hunt)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Functions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Conduction <span class=\"customMeta\" data-dictid=\"12c4510e191692777201c23ec126a3\">velocity</span> (m/sec)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Diameter (µm)</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Myelinated</p>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p> </p>\n<p> </p>\n<p>A</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Alpha</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ia</p>\n<p>Ib</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Proprioception and <span class=\"customMeta\" data-dictid=\"3db910d8571692777198303e3bcb27\">somatic</span> motor</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>70-120</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>12-20</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Beta</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>II</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Touch and pressure</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>30-70</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5-12</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gamma</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Efferent t o muscle spindle</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>15-30</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Delta</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>III</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pain (fast) and temperature (cold)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>12-30</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2-5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Myelinated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>B</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Preganglionic autonomic</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3-12</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Unmyelinated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>C</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IV</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pain (flow) and temperature (warm) and postganglionic</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0.5-2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0.5-2</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which part of the liver stores vitamin A ?", "options": [{"label": "A", "text": "Ito cells", "correct": true}, {"label": "B", "text": "Hepatocytes", "correct": false}, {"label": "C", "text": "Endothelial cells", "correct": false}, {"label": "D", "text": "Kupffer cells", "correct": false}], "correct_answer": "A. Ito cells", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - I\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not synthesized by the liver?", "options": [{"label": "A", "text": "Albumin", "correct": false}, {"label": "B", "text": "Coagulation factors", "correct": false}, {"label": "C", "text": "Acute phase proteins", "correct": false}, {"label": "D", "text": "Immunoglobulin", "correct": true}], "correct_answer": "D. Immunoglobulin", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Product</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Function</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Albumin</p>\n</td>\n<td>\n<p>Maintains <span class=\"customMeta\" data-dictid=\"5d369be246169277719451754ab37a\">oncotic</span> pressure, transports substances,regulates fluid balance</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Coagulation Factors</p>\n</td>\n<td>\n<p>Essential for blood clotting(e.g., fibrinogen, prothrombin, factors VII, VIII, IX, X)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Bile</p>\n</td>\n<td>\n<p>Aids in <span class=\"customMeta\" data-dictid=\"47d4bcce081692777186a1aafdde1a\">digestion</span> and <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> of fats, fat-soluble vitamins, and cholesterol</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Glucose</p>\n</td>\n<td>\n<p>Synthesis of <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> from various sources,helps maintain blood <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> levels</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Urea</p>\n</td>\n<td>\n<p>Product of protein metabolism, excreted in <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> as a waste product</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Acute Phase Proteins</p>\n</td>\n<td>\n<p>Involved in the immune response, inflammation,and tissue repair (e.g., C-reactive protein,haptoglobin, <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"51ad856e041692777181f80c9d507a\">amyloid</span> A)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Lipoproteins</p>\n</td>\n<td>\n<p>Transport of lipids (e.g., LDL, HDL)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Cholesterol</p>\n</td>\n<td>\n<p>Essential for the formation of cell membranes,synthesis of <span class=\"customMeta\" data-dictid=\"a48ce797cd1692777199efc43b3e4c\">steroid</span> hormones</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Bile Acids</p>\n</td>\n<td>\n<p>Aid in fat <span class=\"customMeta\" data-dictid=\"47d4bcce081692777186a1aafdde1a\">digestion</span> and absorption,help solubilize cholesterol</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Fatty Acids</p>\n</td>\n<td>\n<p>Synthesis of lipids, energy production and storage</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Vitamin D</p>\n</td>\n<td>\n<p>Synthesis of active <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of vitamin D(calcitriol)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Blood Proteins</p>\n</td>\n<td>\n<ol>\n<li>Synthesis of various blood proteins,including <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> factors, albumin, etc.</li>\n</ol>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In peripheral oxygen sensing chemoreceptors, which ion is implicated?", "options": [{"label": "A", "text": "Potassium", "correct": true}, {"label": "B", "text": "Calcium", "correct": false}, {"label": "C", "text": "Sodium", "correct": false}, {"label": "D", "text": "Chlorine", "correct": false}], "correct_answer": "A. Potassium", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the defining characteristic of Brown-Séquard syndrome ?", "options": [{"label": "A", "text": "Fine touch lost on the opposite side", "correct": false}, {"label": "B", "text": "Pain and temperature lost on the same side", "correct": false}, {"label": "C", "text": "Pain and temperature loss on the opposite side", "correct": true}, {"label": "D", "text": "Only pain lost on the same side", "correct": false}], "correct_answer": "C. Pain and temperature loss on the opposite side", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Pain and temperature loss on the opposite side: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the following: A. Epidural hematoma i. B. Subdural hematoma ii. C. Subarchniod hemorrhage iii. D. Intracerebral hemorrhage iv.", "options": [{"label": "A", "text": "A-i, B-ii, C-iii, D-iv", "correct": false}, {"label": "B", "text": "b. A-ii, B-iv, C-i, D-iii", "correct": true}, {"label": "C", "text": "A-iv, B-iii, C-ii, D-i", "correct": false}, {"label": "D", "text": "A-i, B-iii, C-ii, D-i", "correct": false}], "correct_answer": "B. b. A-ii, B-iv, C-i, D-iii", "question_images": ["https://image.prepladder.com/content/xl5XEd7uibkOnMOodwpD1687757597.png", "https://image.prepladder.com/content/Dvd5eWIu4RrIECyqcyhA1687757597.png", "https://image.prepladder.com/content/UZ3zRjN1IJiq3gxn5GC11687757597.png", "https://image.prepladder.com/content/WbisWyBI9ngov51kqWgV1687757597.png"], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Intracranial Hemorrhage</strong></p>\n</td>\n<td>\n<p><strong>Key Features</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Epidural Hematoma</p>\n</td>\n<td>\n<ul>\n<li>Typically caused by arterial bleeding</li>\n<li><strong>Lens-shaped blood collection </strong>between the skull and the <span class=\"customMeta\" data-dictid=\"826ce1571f1692777186a0b6e02559\">dura</span> mater</li>\n<li>Associated with head trauma or skull fracture</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Subdural Hematoma</p>\n</td>\n<td>\n<ul>\n<li>Typically caused by <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> bleeding</li>\n<li>Blood collection between the <span class=\"customMeta\" data-dictid=\"826ce1571f1692777186a0b6e02559\">dura</span> <span class=\"customMeta\" data-dictid=\"aaae314d6f1692777191e3350c8ade\">mater</span> and the <span class=\"customMeta\" data-dictid=\"dd3534c97c16927771823c0d04f685\">arachnoid</span> mater</li>\n<li>Can be acute, subacute, or chronic</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Subarachnoid Hemorrhage</p>\n</td>\n<td>\n<ul>\n<li>Bleeding into the <span class=\"customMeta\" data-dictid=\"0a5d82eeef169277719934b86fb07b\">subarachnoid</span> space</li>\n<li>Can result from ruptured aneurysms or head trauma</li>\n<li>Often presents with a sudden severe headache</li>\n<li>May be associated with neck <span class=\"customMeta\" data-dictid=\"b52ddf2a451692777199b4d38e5c53\">stiffness</span> or photophobia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p>Intracerebral Hemorrhage</p>\n</td>\n<td>\n<ul>\n<li>Bleeding within the brain tissue itself</li>\n<li>Can be caused by hypertension, trauma, or other underlying conditions</li>\n<li>Symptoms depend on the location and extent of the bleed, such as weakness, numbness, or changes in consciousness</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What investigation is depicted in the radiograph among the following options?", "options": [{"label": "A", "text": "Barium swallow", "correct": false}, {"label": "B", "text": "Barium meal", "correct": true}, {"label": "C", "text": "Barium meal follow through", "correct": false}, {"label": "D", "text": "Barium enema", "correct": false}], "correct_answer": "B. Barium meal", "question_images": ["https://image.prepladder.com/content/6WOzkkwxk1nlONOfCBwL1697542174.png"], "explanation_images": ["https://image.prepladder.com/content/pF4V1xM6nEwO2yEcG6Hs1697542218.png", "https://image.prepladder.com/content/JBR8vlkElHHc4BQIivVs1697542248.png", "https://image.prepladder.com/content/eiyO6dblaP8kCy5uyvRF1697542274.png", "https://image.prepladder.com/content/904XJHzIZ5pIPXZwhdYt1697542293.png", "https://image.prepladder.com/content/z1ar17dqpbPBMHv5FCe21697542315.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which imaging study is most effective in diagnosing cerebral infarct at the earliest stage?", "options": [{"label": "A", "text": "FLAIR MRI", "correct": false}, {"label": "B", "text": "Non-contrast CT", "correct": false}, {"label": "C", "text": "CECT", "correct": false}, {"label": "D", "text": "d. Diffusion weighted MRI", "correct": true}], "correct_answer": "D. d. Diffusion weighted MRI", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is your diagnosis based on the chest X-ray of a patient during the evaluation of PUO?", "options": [{"label": "A", "text": "Miliary tuberculosis", "correct": true}, {"label": "B", "text": "Pulmonary edema", "correct": false}, {"label": "C", "text": "Necrobiotic nodules", "correct": false}, {"label": "D", "text": "Tuberculoma", "correct": false}], "correct_answer": "A. Miliary tuberculosis", "question_images": ["https://image.prepladder.com/content/wimrQZI1OcbIE4A4h6P51687759349.png"], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Please determine the anatomical structure indicated in the provided MRI scan.", "options": [{"label": "A", "text": "Midbrain", "correct": false}, {"label": "B", "text": "Cerebellum", "correct": true}, {"label": "C", "text": "Brainstem", "correct": false}, {"label": "D", "text": "Cerebrum", "correct": false}], "correct_answer": "B. Cerebellum", "question_images": ["https://image.prepladder.com/content/Kf8P4broqwbCwXlw63Iq1687760042.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is a water soluble contrast?", "options": [{"label": "A", "text": "Iohexol", "correct": true}, {"label": "B", "text": "Barium", "correct": false}, {"label": "C", "text": "Bromium", "correct": false}, {"label": "D", "text": "Calcium", "correct": false}], "correct_answer": "A. Iohexol", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All of the following could be the cause of the presence of free air under the diaphragm except?", "options": [{"label": "A", "text": "Duodenal ulcer perforation", "correct": false}, {"label": "B", "text": "Post laparoscopy", "correct": false}, {"label": "C", "text": "Chilaiditi syndrome", "correct": false}, {"label": "D", "text": "Acute intestinal obstruction", "correct": true}], "correct_answer": "D. Acute intestinal obstruction", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/wTzNF6vRo4x7f0bhxO4W1697542967.png", "https://image.prepladder.com/content/TOw0F3KSqoZzp4x8L6RL1697542943.png", "https://image.prepladder.com/content/2ugE20hEfEqaMwPRTRyW1697542909.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The type of knot seen in the image is?", "options": [{"label": "A", "text": "Half hitch knot", "correct": false}, {"label": "B", "text": "Reef knot", "correct": true}, {"label": "C", "text": "Surgeon’s knot", "correct": false}, {"label": "D", "text": "Crossed half hitch knot", "correct": false}], "correct_answer": "B. Reef knot", "question_images": ["https://image.prepladder.com/content/y0d7aGgVGgaavjsBAbzQ1691504867.png"], "explanation_images": ["https://image.prepladder.com/content/fnMqnTORp29z9QgziRrk1691504890.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the drug used for estrogen dependant breast cancer ?", "options": [{"label": "A", "text": "Lapatinib", "correct": false}, {"label": "B", "text": "Sunitinib", "correct": false}, {"label": "C", "text": "Tamoxifen", "correct": true}, {"label": "D", "text": "Adriamycin", "correct": false}], "correct_answer": "C. Tamoxifen", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - T\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most common surgical approach for a retrosternal goiter ?", "options": [{"label": "A", "text": "Mediastinal incision", "correct": false}, {"label": "B", "text": "Subxiphoid incision", "correct": false}, {"label": "C", "text": "Transaxillary incision", "correct": false}, {"label": "D", "text": "Cervical incision", "correct": true}], "correct_answer": "D. Cervical incision", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\"&gt;Cervical&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most common surgical approach for a retrosternal goiter ?", "options": [{"label": "A", "text": "Mediastinal incision", "correct": false}, {"label": "B", "text": "Subxiphoid incision", "correct": false}, {"label": "C", "text": "Transaxillary incision", "correct": false}, {"label": "D", "text": "Cervical incision", "correct": true}], "correct_answer": "D. Cervical incision", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\"&gt;Cervical&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following steps was done incorrectly by the intern when placing an intercostal drainage tube in the patient?", "options": [{"label": "A", "text": "Identified 5th intercostal space anterior to mid axillary line to place the tube", "correct": false}, {"label": "B", "text": "Inserted above the upper border of the rib", "correct": false}, {"label": "C", "text": "Insertion of the needle, which will be between your ribs on your back", "correct": true}, {"label": "D", "text": "Incised and digitally explored", "correct": false}], "correct_answer": "C. Insertion of the needle, which will be between your ribs on your back", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the size of the given blade used for incision and drainage of a superficial abscess?", "options": [{"label": "A", "text": "10", "correct": false}, {"label": "B", "text": "11", "correct": true}, {"label": "C", "text": "22", "correct": false}, {"label": "D", "text": "15", "correct": false}], "correct_answer": "B. 11", "question_images": ["https://image.prepladder.com/content/UkOJ85pfejYDv4va0FkO1691504947.png"], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old patient presents to the emergency department following a road traffic accident. The radiograph of his pelvis is shown below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Central dislocation of the hip", "correct": false}, {"label": "B", "text": "Fracture shaft of femur", "correct": false}, {"label": "C", "text": "Posterior dislocation of the hip", "correct": true}, {"label": "D", "text": "Anterior dislocation of the hip", "correct": false}], "correct_answer": "C. Posterior dislocation of the hip", "question_images": ["https://image.prepladder.com/content/S3zaZ7stUxHQCTu2q3IK1713873315.png"], "explanation_images": ["https://image.prepladder.com/content/fo7pFS6h0buGjcZYVd9z1713873116.png"], "explanation": "<p>Correct Option C - Posterior &lt;span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\"&gt;dislocation&lt;/span&gt; of the h\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 12-year-old boy presents with a gradually progressing swelling and dull aching pain since 6 months in his lower leg .He is otherwise healthy. The radiographic image of his leg is shown below. The most likely diagnosis is:", "options": [{"label": "A", "text": "Osteosarcoma", "correct": false}, {"label": "B", "text": "Osteoblastoma", "correct": false}, {"label": "C", "text": "Brodie's abscess", "correct": true}, {"label": "D", "text": "Ewing's sarcoma", "correct": false}], "correct_answer": "C. Brodie's abscess", "question_images": ["https://image.prepladder.com/content/NL3ETqFyDXFRxmsE1nzr1691507447.png"], "explanation_images": [], "explanation": "<p>Correct Option C - Brodie's A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which organ is the least susceptible to the blast wave in a blast injury?", "options": [{"label": "A", "text": "Gl tract", "correct": false}, {"label": "B", "text": "Lungs", "correct": false}, {"label": "C", "text": "Liver", "correct": true}, {"label": "D", "text": "Ear drum", "correct": false}], "correct_answer": "C. Liver", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following fractures is most prone to non-union?", "options": [{"label": "A", "text": "Proximal scaphoid", "correct": true}, {"label": "B", "text": "Inter-trochanteric", "correct": false}, {"label": "C", "text": "Distal radius", "correct": false}, {"label": "D", "text": "Talar neck", "correct": false}], "correct_answer": "A. Proximal scaphoid", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/vw0VLCPeuEPlEC9mMXY31687772482.png", "https://image.prepladder.com/content/SG1r5aMKgcvIdqWZbZdn1687772482.png"], "explanation": "<p>Correct Option A - Proximal Scaph\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A male patient comes with a gradually increasing enlargement for the past one and a half years. Upon examination, the swelling demonstrates inconsistency in texture and matches the appearance depicted in the provided image. What is the likely underlying reason for this?", "options": [{"label": "A", "text": "Jaw Tumour", "correct": false}, {"label": "B", "text": "Dermoid cyst", "correct": false}, {"label": "C", "text": "Pleomorphic adenoma", "correct": true}, {"label": "D", "text": "Sebaceous cyst", "correct": false}], "correct_answer": "C. Pleomorphic adenoma", "question_images": ["https://image.prepladder.com/content/LSlvfRnqrSK0l0iWjHUS1691507302.png"], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following best describes the condition known as \"painful arc syndrome\"?", "options": [{"label": "A", "text": "A condition in which joint stiffness lasts for more than 30 minutes in the morning, affecting multiple joints.", "correct": false}, {"label": "B", "text": "A condition characterized by localized, sharp pain at the site of an injury or inflammation.", "correct": false}, {"label": "C", "text": "A condition where pain is experienced during a specific range of motion, typically between 60 and 120 degrees of shoulder abduction.", "correct": true}, {"label": "D", "text": "A condition marked by generalized musculoskeletal pain, fatigue, and tender points in various areas of the body.", "correct": false}], "correct_answer": "C. A condition where pain is experienced during a specific range of motion, typically between 60 and 120 degrees of shoulder abduction.", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - A condition where pain is experienced during a specific range of motion, typically between 60 and 120 degrees of shoulder abdu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is shown in the given image?", "options": [{"label": "A", "text": "Dermoid cyst", "correct": false}, {"label": "B", "text": "Sebaceous cyst", "correct": true}, {"label": "C", "text": "Meningioma", "correct": false}, {"label": "D", "text": "Post auricular fistula", "correct": false}], "correct_answer": "B. Sebaceous cyst", "question_images": ["https://image.prepladder.com/content/95cXMrkb6wOonaDil8T01691507210.png"], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "De-gloving injury refers to_____?", "options": [{"label": "A", "text": "Skin and subcutaneous fat are stripped from the underlying fascia", "correct": true}, {"label": "B", "text": "Skin, subcutaneous fat and fascia are stripped from tendons", "correct": false}, {"label": "C", "text": "Skin, subcutaneous fat, fascia and tendons are stripped from bone", "correct": false}, {"label": "D", "text": "Only skin is stripped off", "correct": false}], "correct_answer": "A. Skin and subcutaneous fat are stripped from the underlying fascia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Skin and &lt;span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\"&gt;subcutaneous&lt;/span&gt; fat are stripped from the underlying\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "How to manage a patient of Rheumatoid arthritis with deformity?", "options": [{"label": "A", "text": "Steroids", "correct": false}, {"label": "B", "text": "Methotrexate with steroids", "correct": false}, {"label": "C", "text": "Methotrexate with anti-TNF", "correct": true}, {"label": "D", "text": "Steroids only after NSAlDs fail", "correct": false}], "correct_answer": "C. Methotrexate with anti-TNF", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Methotrexate with anti-TNF\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female patient presents with a breast abscess . Under antibiotic cover, an aspiration was attempted which failed to reveal any aspirate . What is the next step in management?", "options": [{"label": "A", "text": "Incision and Drainage", "correct": false}, {"label": "B", "text": "Continue antibiotics only", "correct": false}, {"label": "C", "text": "Incision and drainage + Antibiotics", "correct": true}, {"label": "D", "text": "Stop antibiotics as no aspirate was collected", "correct": false}], "correct_answer": "C. Incision and drainage + Antibiotics", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Da8xaHokdxNhHmPCIN7B1714388588.png"], "explanation": "<p>Correct Option C - Incision and &lt;span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\"&gt;drainage&lt;/span&gt; + A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60 year old woman presents with low backache and on a lumbar CT the following is seen. What is your diagnosis?", "options": [{"label": "A", "text": "Spondylolisthesis", "correct": false}, {"label": "B", "text": "Discitis", "correct": false}, {"label": "C", "text": "Osteoporosis", "correct": true}, {"label": "D", "text": "Pott's spine", "correct": false}], "correct_answer": "C. Osteoporosis", "question_images": ["https://image.prepladder.com/content/0MiBslpGUmONR8n0Edh71691507116.png"], "explanation_images": [], "explanation": "<p>Correct Option C - O\n<p><strong>References:</strong></p>\n<ul><li>↳ individual's BMD and the average BMD of the young</li><li>↳ healthy reference populatio</li><li>↳ T-Score Bone Density Status &gt; -1.0 Normal -1.0 to -2.5 Osteopenia (Low bone density) &lt; -2.5 Osteoporosis &lt; -2.5 with fragility fracture Severe Osteoporosis</li><li>↳ T-Score Bone Density Status</li><li>↳ T-Score</li><li>↳ T-Score</li><li>↳ T-Score</li><li>↳ Bone Density Status</li><li>↳ Bone Density Status</li><li>↳ Bone Density Status</li><li>↳ &gt; -1.0 Normal</li><li>↳ &gt; -1.0</li><li>↳ &gt; -1.0</li><li>↳ Normal</li><li>↳ Normal</li><li>↳ -1.0 to -2.5 Osteopenia (Low bone density)</li><li>↳ -1.0 to -2.5</li><li>↳ -1.0 to -2.5</li><li>↳ Osteopenia (Low bone density)</li><li>↳ Osteopenia (Low bone density)</li><li>↳ &lt; -2.5 Osteoporosis</li><li>↳ &lt; -2.5</li><li>↳ &lt; -2.5</li><li>↳ Osteoporosis</li><li>↳ Osteoporosis</li><li>↳ &lt; -2.5 with fragility fracture Severe Osteoporosis</li><li>↳ &lt; -2.5 with fragility fracture</li><li>↳ &lt; -2.5 with fragility fracture</li><li>↳ Severe Osteoporosis</li><li>↳ Severe Osteoporosis</li></ul>\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>T-Score</strong></p>\n</td>\n<td>\n<p><strong>Bone Density Status</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>&gt; -1.0</p>\n</td>\n<td>\n<p>Normal</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>-1.0 to -2.5</p>\n</td>\n<td>\n<p>Osteopenia (Low bone density)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>&lt; -2.5</p>\n</td>\n<td>\n<p>Osteoporosis</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>&lt; -2.5 with <span class=\"customMeta\" data-dictid=\"0f4e78e9121692777203594ba840cc\">fragility</span> fracture</p>\n</td>\n<td>\n<p>Severe Osteoporosis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which specific nerve is affected in Frey's syndrome?", "options": [{"label": "A", "text": "Facial Nerve", "correct": false}, {"label": "B", "text": "Oculomotor nerve", "correct": false}, {"label": "C", "text": "Auriculotemporal nerve", "correct": true}, {"label": "D", "text": "Glossopharyngeal nerve", "correct": false}], "correct_answer": "C. Auriculotemporal nerve", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/hDXfdQMTlOhJqA44MKck1687773809.png", "https://image.prepladder.com/content/fcvb0hxuydLPQJ54zSYV1687773813.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An 18-year-old boy presents to the orthopedician with complaints of painful swelling below the knee joint. An X-Ray was obtained which is given below. Which of the following is the preferred treatment modality for this patient?", "options": [{"label": "A", "text": "Extended curettage and bone grafting", "correct": true}, {"label": "B", "text": "Simple curettage and bone grafting", "correct": false}, {"label": "C", "text": "Radiofrequency ablation", "correct": false}, {"label": "D", "text": "Radical excision", "correct": false}], "correct_answer": "A. Extended curettage and bone grafting", "question_images": ["https://image.prepladder.com/content/nx9IO73gzkWQ0IhxM76V1695560512.png"], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The following images A and B show?", "options": [{"label": "A", "text": "Mallet finger &amp;amp; Jersey finger", "correct": false}, {"label": "B", "text": "Boxer fracture &amp;amp; march fracture", "correct": false}, {"label": "C", "text": "Mallet finger &amp;amp; boxer fracture", "correct": false}, {"label": "D", "text": "Jersey finger &amp;amp; baseball finger", "correct": true}], "correct_answer": "D. Jersey finger &amp; baseball finger", "question_images": ["https://image.prepladder.com/content/GrmdCaGSYyNRhIaWiR961695560591.png"], "explanation_images": [], "explanation": "<p>Correct Option D - Jersey finger &amp;amp; baseball fing\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Hand Injury</strong></p>\n</td>\n<td>\n<p><strong>Explanation</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Gamekeeper's Thumb</p>\n</td>\n<td>\n<p>Injury to the<strong> <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> <span class=\"customMeta\" data-dictid=\"4de12d1ef31692777184db1d11c6bd\">collateral</span> <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> (UCL) of the thumb</strong>, usually resulting from a <strong>forceful <span class=\"customMeta\" data-dictid=\"69ae073b9f169277718021ae773099\">abduction</span> or <span class=\"customMeta\" data-dictid=\"2ad2fb4cc8169277718925a677620c\">hyperextension</span> of the thumb</strong>.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Mallet Finger</p>\n</td>\n<td>\n<p>Injury to the <strong>extensor <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> of the finger, specifically at the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"65604d11831692777190c5ea442405\">interphalangeal</span> (DIP) joint.</strong> This injury is often caused by a forceful blow to the fingertip or by forcefully jamming the finger.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Jersey Finger</p>\n</td>\n<td>\n<p>Injury to the <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">flexor</span> <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> of the finger, specifically at the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"65604d11831692777190c5ea442405\">interphalangeal</span> (DIP) joint. It occurs when the <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">flexor</span> <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> is torn or avulsed from its <span class=\"customMeta\" data-dictid=\"ccd357daaf16927771825777ea6a0d\">attachment</span> to the bone, typically due to forceful extension of the finger while it is actively flexed, such as when trying to grab an opponent's jersey in sports.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Trigger Finger</p>\n</td>\n<td>\n<p>A condition characterized by the <strong>inflammation and narrowing of the <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">flexor</span> <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> <span class=\"customMeta\" data-dictid=\"44e9c0bbec169277719829907370ee\">sheath</span> in the finger. </strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Boxer's Fracture</p>\n</td>\n<td>\n<p>A <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> of the <span class=\"customMeta\" data-dictid=\"3582e886271692777192ab233546a6\">metacarpal</span> bone in the hand, specifically the<strong> neck of the metacarpal. </strong>It usually results from a direct impact with a closed fist, such as during a punch.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is not true regarding deep vein thrombosis (DVT)?", "options": [{"label": "A", "text": "Clinical assessment is unreliable", "correct": false}, {"label": "B", "text": "Mostly bilateral", "correct": true}, {"label": "C", "text": "Most common clinical presentation is pain and tenderness in calf", "correct": false}, {"label": "D", "text": "Some cases may directly present as pulmonary thromboembolism", "correct": false}], "correct_answer": "B. Mostly bilateral", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is true regarding the dose-response curve shown in the image below ?", "options": [{"label": "A", "text": "C is competitive antagonist", "correct": false}, {"label": "B", "text": "C is more potent than A", "correct": false}, {"label": "C", "text": "B is more potent than A", "correct": false}, {"label": "D", "text": "B is competitive antagonist", "correct": true}], "correct_answer": "D. B is competitive antagonist", "question_images": ["https://image.prepladder.com/content/ytghAipXzRjtPJTWaYpq1691506846.png"], "explanation_images": [], "explanation": "<p>Correct Option D - B is competitive antag\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the CEAP stage of clinical classification for chronic venous disorders in a truck driver who has dilated, tortuous veins measuring 4 mm in the foot?", "options": [{"label": "A", "text": "C0", "correct": false}, {"label": "B", "text": "C1", "correct": false}, {"label": "C", "text": "C2", "correct": true}, {"label": "D", "text": "C3", "correct": false}], "correct_answer": "C. C2", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following antiglaucoma medications is unsafe in infants ?", "options": [{"label": "A", "text": "Timolol", "correct": false}, {"label": "B", "text": "Brimonidine", "correct": true}, {"label": "C", "text": "Latanoprost", "correct": false}, {"label": "D", "text": "Dorzolamide", "correct": false}], "correct_answer": "B. Brimonidine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - B\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Apparent volume of distribution of a drug is very high (6L/kg) . Which of the following is true regarding the distribution of that drug ?", "options": [{"label": "A", "text": "Highly bound to plasma proteins", "correct": false}, {"label": "B", "text": "Confined to vascular compartment", "correct": false}, {"label": "C", "text": "Sequestered in body tissues", "correct": true}, {"label": "D", "text": "Both A and B", "correct": false}], "correct_answer": "C. Sequestered in body tissues", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Sequestered in body tissu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which phase of a clinical trial is primarily focused on assessing the preliminary efficacy and determining the optimal dose of a drug?", "options": [{"label": "A", "text": "Phase 1", "correct": false}, {"label": "B", "text": "Phase 2", "correct": true}, {"label": "C", "text": "Phase 3", "correct": false}, {"label": "D", "text": "Phase 4", "correct": false}], "correct_answer": "B. Phase 2", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/hrsSwRp13Mxt5nYIGdJa1724844502.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 56-year-old patient suffering from alcoholic cirrhosis receives a healthy liver from his biological son. What is this type of transplant known as?", "options": [{"label": "A", "text": "Autograft", "correct": false}, {"label": "B", "text": "Allograft", "correct": true}, {"label": "C", "text": "Xenograft", "correct": false}, {"label": "D", "text": "Isograft", "correct": false}], "correct_answer": "B. Allograft", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which one of the options below is not included in the revised trauma score (RTS)?", "options": [{"label": "A", "text": "Glasgow coma scale", "correct": false}, {"label": "B", "text": "Systolic blood pressure", "correct": false}, {"label": "C", "text": "Pulse rate", "correct": true}, {"label": "D", "text": "Respiratory rate", "correct": false}], "correct_answer": "C. Pulse rate", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Revised trauma score (RTS)</strong></p>\n</td>\n<td>\n<p><strong>Trauma &amp; injury severity score (TRISS)</strong></p>\n</td>\n<td>\n<p><strong>Mangled <span class=\"customMeta\" data-dictid=\"c8ed8e0fb61692777187c860f7056f\">Extremity</span> severity score (MESS)</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>(Mnemonic- GB Road)</p>\n<ul>\n<li>G - GCS</li>\n<li>B - Bp (systolic)</li>\n<li>Road - <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> rate</li>\n</ul>\n</td>\n<td>\n<p>(Mnemonic- ISS + RAM)</p>\n<ul>\n<li>SS - Injury severity score</li>\n<li><strong>R</strong> - Revised trauma score - A-Age</li>\n<li><strong>M</strong>-Mechanism (blunt/penetrating)</li>\n</ul>\n</td>\n<td>\n<p>(Mnemonic- ELISA)</p>\n<ul>\n<li>E-Energy</li>\n<li>Li- Limb Ischemia</li>\n<li>S-Shock</li>\n<li>A-Age</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is an oral factor Xa inhibitor ?", "options": [{"label": "A", "text": "Bivalirudin", "correct": false}, {"label": "B", "text": "Dabigatran", "correct": false}, {"label": "C", "text": "Rivaroxaban", "correct": true}, {"label": "D", "text": "Enoxaparin", "correct": false}], "correct_answer": "C. Rivaroxaban", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Riv\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Type of Anticoagulant</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Mechanism of Action</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Vitamin K antagonists(e.g., warfarin)</p>\n</td>\n<td>\n<p>Inhibit the <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> <span class=\"customMeta\" data-dictid=\"71c2092f15169277720243eb1590b0\">vitamin K</span> <span class=\"customMeta\" data-dictid=\"29ca44bd601692777187c3d92d645b\">epoxide</span> reductase, which is responsible for the conversion of <span class=\"customMeta\" data-dictid=\"71c2092f15169277720243eb1590b0\">vitamin K</span> <span class=\"customMeta\" data-dictid=\"29ca44bd601692777187c3d92d645b\">epoxide</span> to its active form. This inhibits the <span class=\"customMeta\" data-dictid=\"3fda45538a1692777199ec2a5478a5\">synthesis</span> of vitamin K-dependent <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> factors II, VII, IX, and X.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Direct <span class=\"customMeta\" data-dictid=\"ac7e1f394f1692777200c5bb11e4d8\">thrombin</span> inhibitors(e.g., dabigatran)</p>\n</td>\n<td>\n<p>Bind directly to <span class=\"customMeta\" data-dictid=\"ac7e1f394f1692777200c5bb11e4d8\">thrombin</span> (factor IIa), inhibiting its ability to convert <span class=\"customMeta\" data-dictid=\"a137b7092a16927772025412d4ef05\">fibrinogen</span> to <span class=\"customMeta\" data-dictid=\"18c2380be716927772020c9b2863de\">fibrin</span> and preventing <span class=\"customMeta\" data-dictid=\"56c933e0d41692777200b713c46640\">thrombus</span> formation.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Factor Xa inhibitors(e.g., rivaroxaban, apixaban)</p>\n</td>\n<td>\n<p>Inhibit the activity of factor Xa, which plays a key role in the <span class=\"customMeta\" data-dictid=\"42f1e4deb8169277718412c0681a54\">coagulation</span> <span class=\"customMeta\" data-dictid=\"6826aa04ef16927771833336e53730\">cascade</span> by converting <span class=\"customMeta\" data-dictid=\"94b02f097916927771962072dbeeac\">prothrombin</span> to thrombin. By inhibiting factor Xa, these drugs prevent the formation of <span class=\"customMeta\" data-dictid=\"18c2380be716927772020c9b2863de\">fibrin</span> and subsequent <span class=\"customMeta\" data-dictid=\"5e0b40993316927771844dbf382689\">clot</span> formation.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Heparins(e.g., unfractionated heparin, low <span class=\"customMeta\" data-dictid=\"b2df2436bf1692777193d90e9c0132\">molecular weight</span> heparins)</p>\n</td>\n<td>\n<p>Enhance the activity of <span class=\"customMeta\" data-dictid=\"fa202015a216927771814a0dc268ba\">antithrombin</span> III, a natural <span class=\"customMeta\" data-dictid=\"b5fb56a28b1692777190396ae8b625\">inhibitor</span> of <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> factors. This increases the <span class=\"customMeta\" data-dictid=\"f03ca2d2a716927771901227bc175a\">inhibition</span> of factors IIa (thrombin) and factor Xa, leading to decreased <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> activity.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the drug of choice for diphtheria carrier state ?", "options": [{"label": "A", "text": "Amoxicillin", "correct": false}, {"label": "B", "text": "Erythromycin", "correct": true}, {"label": "C", "text": "Rifampicin", "correct": false}, {"label": "D", "text": "Tetracycline", "correct": false}], "correct_answer": "B. Erythromycin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Eryth\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Type of Diphtheria</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Treatment of Choice</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Respiratory diphtheria</strong></p>\n</td>\n<td>\n<ul>\n<li>\n<p>Diphtheria <span class=\"customMeta\" data-dictid=\"2ff0b3039f16927771818bb2a247b0\">antitoxin</span> (DAT)</p>\n</li>\n<li>\n<p>Antibiotic therapy (e.g., erythromycin)</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Cutaneous diphtheria</strong></p>\n</td>\n<td>\n<ul>\n<li>\n<p>Local wound care</p>\n</li>\n<li>\n<p>Antibiotic therapy (e.g., erythromycin)</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Nasopharyngeal diphtheria</strong></p>\n<p><strong>Laryngeal or pharyngeal diphtheria</strong></p>\n</td>\n<td>\n<ul>\n<li>\n<p>Diphtheria <span class=\"customMeta\" data-dictid=\"2ff0b3039f16927771818bb2a247b0\">antitoxin</span> (DAT)</p>\n</li>\n<li>\n<p>Antibiotic therapy (e.g., erythromycin)</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Diphtheria carrier state</strong></p>\n</td>\n<td>\n<ul>\n<li>\n<p>Antibiotic therapy (e.g., erythromycin)</p>\n</li>\n<li>\n<p>Close contact prophylaxis</p>\n</li>\n<li>\n<p>Immunization of contacts and carriers</p>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the mechanism of action of oseltamivir and zanamivir ?", "options": [{"label": "A", "text": "DNA polymerase inhibition", "correct": false}, {"label": "B", "text": "Protein synthesis inhibition", "correct": false}, {"label": "C", "text": "Nucleotide analogue", "correct": false}, {"label": "D", "text": "Neuraminidase inhibition", "correct": true}], "correct_answer": "D. Neuraminidase inhibition", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"257d9cb9fb1692777193840b7918f6\"&gt;Neuraminidase&lt;/span&gt; inhibition.\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the subsequent options is an abortifacient, derived from synthetic PFG2 alpha?", "options": [{"label": "A", "text": "Dinoprost", "correct": false}, {"label": "B", "text": "Dinoprostone", "correct": false}, {"label": "C", "text": "Misoprostol", "correct": false}, {"label": "D", "text": "Carboprost", "correct": true}], "correct_answer": "D. Carboprost", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option d. Carboprost.\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Prostaglandin Analogue</strong></p>\n</td>\n<td>\n<p><strong>Uses</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Dinoprost (PGF2 alpha)</p>\n</td>\n<td>\n<p>- <span class=\"customMeta\" data-dictid=\"f447020b9616927771904d1c923d80\">Induction</span> of labor</p>\n<p>- Treatment of <span class=\"customMeta\" data-dictid=\"3d885759d516927771966b84bfa470\">postpartum</span> hemorrhage</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table>\n<tbody>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<p><strong>- Control of <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> bleeding</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Dinoprostone (PGE2)</p>\n</td>\n<td>\n<p>- <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">Cervical</span> ripening</p>\n<p>- <span class=\"customMeta\" data-dictid=\"f447020b9616927771904d1c923d80\">Induction</span> of labor</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table>\n<tbody>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<p><strong>- <span class=\"customMeta\" data-dictid=\"a35c217ec416927772009a7f3b20f4\">Termination</span> of pregnancy (medical abortion)</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Misoprostol (PGE1)</p>\n</td>\n<td>\n<p>- <span class=\"customMeta\" data-dictid=\"a35c217ec416927772009a7f3b20f4\">Termination</span> of pregnancy (medical abortion)</p>\n<p>- <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">Cervical</span> ripening</p>\n<p>- Prevention and treatment of <span class=\"customMeta\" data-dictid=\"3d885759d516927771966b84bfa470\">postpartum</span> hemorrhage</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table>\n<tbody>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<p><strong>- Prevention of <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> ulcers in certain cases</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Carboprost (PGF2 alpha)</p>\n</td>\n<td>\n<p>- <span class=\"customMeta\" data-dictid=\"a35c217ec416927772009a7f3b20f4\">Termination</span> of pregnancy</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table>\n<tbody>\n<tr>\n<td>\n<p> </p>\n</td>\n<td>\n<p><strong>- Prevention and treatment of <span class=\"customMeta\" data-dictid=\"3d885759d516927771966b84bfa470\">postpartum</span> hemorrhage</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following drugs causes activation of K+-ATP channels ?", "options": [{"label": "A", "text": "Nicorandil", "correct": true}, {"label": "B", "text": "Molsidomine", "correct": false}, {"label": "C", "text": "Isosorbide dinitrate", "correct": false}, {"label": "D", "text": "Nitroglycerin", "correct": false}], "correct_answer": "A. Nicorandil", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - N\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Most effective antiemetic for chemotherapy–induced vomiting is _____________.", "options": [{"label": "A", "text": "Domperidone", "correct": false}, {"label": "B", "text": "Tegaserod", "correct": false}, {"label": "C", "text": "Granisetron", "correct": true}, {"label": "D", "text": "Doxylamine", "correct": false}], "correct_answer": "C. Granisetron", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - G\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Nasal polyps are commonly associated with which of the following?", "options": [{"label": "A", "text": "Intrinsic asthma", "correct": true}, {"label": "B", "text": "Brittle asthma", "correct": false}, {"label": "C", "text": "Extrinsic asthma", "correct": false}, {"label": "D", "text": "Exercise - induced asthma", "correct": false}], "correct_answer": "A. Intrinsic asthma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "True statement about teduglutide is :", "options": [{"label": "A", "text": "It is a GLP-2 analogue", "correct": true}, {"label": "B", "text": "It’s half life is 6-8 hours", "correct": false}, {"label": "C", "text": "It is administered orally", "correct": false}, {"label": "D", "text": "It is recommended for patients with colorectal cancer", "correct": false}], "correct_answer": "A. It is a GLP-2 analogue", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - It is a GLP-2 analogu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Why is cisatracurium preferred over atracurium?", "options": [{"label": "A", "text": "It has rapid onset of action", "correct": false}, {"label": "B", "text": "It has less depressant action on heart", "correct": false}, {"label": "C", "text": "It has short duration of action", "correct": false}, {"label": "D", "text": "It causes less release of histamine", "correct": true}], "correct_answer": "D. It causes less release of histamine", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All of the following are AIDS defining illnesses except:", "options": [{"label": "A", "text": "Encephalopathy attributed to HIV", "correct": false}, {"label": "B", "text": "Invasive cervical cancer", "correct": false}, {"label": "C", "text": "Mycobacterium tuberculosis of any site", "correct": false}, {"label": "D", "text": "Oral candidiasis", "correct": true}], "correct_answer": "D. Oral candidiasis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - O\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which one of the following drugs inhibits neutrophil recruitment ?", "options": [{"label": "A", "text": "Montelukast", "correct": false}, {"label": "B", "text": "Sodium cromolyn", "correct": false}, {"label": "C", "text": "Colchicine", "correct": true}, {"label": "D", "text": "Febuxostat", "correct": false}], "correct_answer": "C. Colchicine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Colch\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 47-year-old man with a diagnosis of acute myeloid leukemia with a blood type O negative presents to the transplant clinic to discuss proceeding with an allogeneic stem cell transplant. Which of the following would be an optimal donor?", "options": [{"label": "A", "text": "His brother", "correct": false}, {"label": "B", "text": "Umbilical cord transplant", "correct": false}, {"label": "C", "text": "His HLA twin identical brother who is otherwise healthy and is blood type O+", "correct": true}, {"label": "D", "text": "An HLA identical matched unrelated donor", "correct": false}], "correct_answer": "C. His HLA twin identical brother who is otherwise healthy and is blood type O+", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - His &lt;span class=\"customMeta\" data-dictid=\"b1debe2a7c16927771890479332d98\"&gt;HLA&lt;/span&gt; twin identical brother who is otherwise healthy and is &lt;span class=\"customMeta\" data-dictid=\"8cb71c753c16927771831c74cb7271\"&gt;blood type&lt;/span&gt; O+\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following fluoroquinolones has maximum bioavailability ?", "options": [{"label": "A", "text": "Ciprofloxacin", "correct": false}, {"label": "B", "text": "Levofloxacin", "correct": true}, {"label": "C", "text": "Gatifloxacin", "correct": false}, {"label": "D", "text": "Norfloxacin", "correct": false}], "correct_answer": "B. Levofloxacin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Levofloxacin.\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the mechanism of triazoles ?", "options": [{"label": "A", "text": "Interferes with DNA and RNA synthesis", "correct": false}, {"label": "B", "text": "Inhibition of ergosterol synthesis", "correct": true}, {"label": "C", "text": "Forms pores in fungal membranes", "correct": false}, {"label": "D", "text": "Inhibits epoxidation of squalene in fungi", "correct": false}], "correct_answer": "B. Inhibition of ergosterol synthesis", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A dermatologist wants to prescribe acitretin to a patient with psoriasis . Which of the following statements is false regarding the drug?", "options": [{"label": "A", "text": "Contraindicated in persons with hyperlipidemia", "correct": false}, {"label": "B", "text": "It can cause increased sensitivity to sunlight", "correct": false}, {"label": "C", "text": "Female patients should avoid getting pregnant for 6 months after therapy", "correct": true}, {"label": "D", "text": "Acitretin has a half life of about 50 hours", "correct": false}], "correct_answer": "C. Female patients should avoid getting pregnant for 6 months after therapy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Female patients should avoid getting pregnant for 6 months after th\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align:center\"><strong>Drug Classification</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Examples</strong></p>\n</td>\n<td>\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Retinoids</p>\n</td>\n<td>\n<p>Isotretinoin, Acitretin</p>\n</td>\n<td>\n<p>Used to treat <span class=\"customMeta\" data-dictid=\"8b61bc6e361692777180695ac33e91\">acne</span> and other <span class=\"customMeta\" data-dictid=\"193e0fc1471692777186c661338b8e\">dermatological</span> conditions.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>ACE inhibitors</p>\n</td>\n<td>\n<p>Lisinopril, Enalapril</p>\n</td>\n<td>\n<p>Used to treat <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> and heart failure.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Anticoagulants</p>\n</td>\n<td>\n<p>Warfarin, Heparin</p>\n</td>\n<td>\n<p>Used to prevent or treat blood <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> disorders.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Thalidomide and analogs</p>\n</td>\n<td>\n<p>Thalidomide</p>\n</td>\n<td>\n<p>Previously used as a <span class=\"customMeta\" data-dictid=\"dd4bbf3a1a16927771988e61c3d5e9\">sedative</span> and caused severe birth defects.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Lithium</p>\n</td>\n<td>\n<p>Lithium carbonate</p>\n</td>\n<td>\n<p>Used to treat <span class=\"customMeta\" data-dictid=\"df4ae006fe1692777183604169e9b2\">bipolar</span> disorder and depression.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Androgens</p>\n</td>\n<td>\n<p>Testosterone</p>\n</td>\n<td>\n<p>Used in hormone replacement therapy and hypogonadism.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old HIV positive man presents with fever for 3 weeks, dry cough an significant weight loss . His chest x-ray is given below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Staphylococcal pneumonia", "correct": false}, {"label": "B", "text": "Pneumococcal pneumonia", "correct": false}, {"label": "C", "text": "Tuberculosis", "correct": false}, {"label": "D", "text": "Pneumocystis jirovecii pneumonia", "correct": true}], "correct_answer": "D. Pneumocystis jirovecii pneumonia", "question_images": ["https://image.prepladder.com/content/aQktnPWYOA9U7w4P9Olr1712048427.png"], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"af71e1cffa16927771950a5fb2c281\"&gt;Pneumocystis&lt;/span&gt; jirovecii &lt;span class=\"customMeta\" data-dictid=\"1000989d33169277719652247cd559\"&gt;pneumonia&lt;/span&gt; (PJP)\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which drug's action is prolonged by the administration of cilastatin?", "options": [{"label": "A", "text": "Meropenem", "correct": false}, {"label": "B", "text": "Imipenem", "correct": true}, {"label": "C", "text": "Cefazolin", "correct": false}, {"label": "D", "text": "Piperacillin", "correct": false}], "correct_answer": "B. Imipenem", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - I\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the drug used to differentiate myasthenia gravis from cholinergic crisis ?", "options": [{"label": "A", "text": "Obidoxime", "correct": false}, {"label": "B", "text": "Edrophonium", "correct": true}, {"label": "C", "text": "Donepezil", "correct": false}, {"label": "D", "text": "Atropine", "correct": false}], "correct_answer": "B. Edrophonium", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Edrophoniu\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Aspect</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Myasthenia Gravis (MG)</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Cholinergic Crisis</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Edrophonium Test</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Definition</strong></p>\n</td>\n<td>\n<p>Autoimmune disorder affecting <span class=\"customMeta\" data-dictid=\"8b19cd5e161692777193ad958e52e0\">neuromuscular</span> junction</p>\n</td>\n<td>\n<p>Excessive <span class=\"customMeta\" data-dictid=\"7f3792072b1692777199fd8e2c4f59\">stimulation</span> of <span class=\"customMeta\" data-dictid=\"8656dac49a16927771846b41f8cf19\">cholinergic</span> receptors</p>\n</td>\n<td>\n<p><strong>Diagnostic test t</strong>o <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> MG from <span class=\"customMeta\" data-dictid=\"8656dac49a16927771846b41f8cf19\">cholinergic</span> crisis</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Symptoms</strong></p>\n</td>\n<td>\n<p>Muscle weakness, fatigue</p>\n</td>\n<td>\n<p>Profound muscle weakness, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> distress</p>\n</td>\n<td>\n<p>Temporary improvement of <span class=\"customMeta\" data-dictid=\"cba1b0e9ae1692777193338c1ab85f\">muscle strength</span> in MG, worsening of symptoms in <span class=\"customMeta\" data-dictid=\"8656dac49a16927771846b41f8cf19\">cholinergic</span> crisis</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Cause</strong></p>\n</td>\n<td>\n<p>Antibodies attacking <span class=\"customMeta\" data-dictid=\"a79a62c36e169277718062f9630d56\">acetylcholine</span> receptors</p>\n</td>\n<td>\n<p>Excessive <span class=\"customMeta\" data-dictid=\"a79a62c36e169277718062f9630d56\">acetylcholine</span> due to overstimulation</p>\n</td>\n<td>\n<ul>\n<li><strong>In MG:</strong> Temporary increase in <span class=\"customMeta\" data-dictid=\"a79a62c36e169277718062f9630d56\">acetylcholine</span> concentration at <span class=\"customMeta\" data-dictid=\"8b19cd5e161692777193ad958e52e0\">neuromuscular</span> junction</li>\n<li><strong>In <span class=\"customMeta\" data-dictid=\"8656dac49a16927771846b41f8cf19\">Cholinergic</span> Crisis</strong>: Worsening of symptoms due to increased <span class=\"customMeta\" data-dictid=\"a79a62c36e169277718062f9630d56\">acetylcholine</span> levels</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Response to Edrophonium</strong></p>\n</td>\n<td>\n<p>Temporary improvement in muscle strength</p>\n</td>\n<td>\n<p>Worsening of symptoms</p>\n</td>\n<td>\n<p>Positive response in MG, Negative/worsening response in <span class=\"customMeta\" data-dictid=\"8656dac49a16927771846b41f8cf19\">cholinergic</span> crisis</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"1\" rowspan=\"2\">\n<p><strong>Mechanism</strong></p>\n<p> </p>\n</td>\n<td colspan=\"1\" rowspan=\"2\">\n<p>Acetylcholinesterase inhibitor</p>\n<p> </p>\n</td>\n<td colspan=\"1\" rowspan=\"2\">\n<p>Acetylcholine <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> overstimulation</p>\n<p> </p>\n</td>\n<td colspan=\"1\" rowspan=\"2\">\n<ul>\n<li><strong>In MG</strong>: Inhibits acetylcholinesterase, increasing <span class=\"customMeta\" data-dictid=\"a79a62c36e169277718062f9630d56\">acetylcholine</span> availability</li>\n<li><strong>In <span class=\"customMeta\" data-dictid=\"8656dac49a16927771846b41f8cf19\">Cholinergic</span> Crisis</strong>: Further increases <span class=\"customMeta\" data-dictid=\"a79a62c36e169277718062f9630d56\">acetylcholine</span> levels, worsening symptoms</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is false regarding Guillain-Barre syndrome?", "options": [{"label": "A", "text": "Ascending paralysis", "correct": false}, {"label": "B", "text": "Descending paralysis is seen", "correct": true}, {"label": "C", "text": "Plasmapheresis is a treatment method", "correct": false}, {"label": "D", "text": "Demyelinating disorder", "correct": false}], "correct_answer": "B. Descending paralysis is seen", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\"&gt;Descending&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"72fa9105b916927771945aef35e8ed\"&gt;paralysis&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the statements below correctly describes pegylated filgrastim?", "options": [{"label": "A", "text": "Duration of action is shorter than normal filgrastim", "correct": false}, {"label": "B", "text": "Added advantage is that it can be taken orally", "correct": false}, {"label": "C", "text": "It should not be administered in sickle cell patients", "correct": true}, {"label": "D", "text": "It is not effective in the treatment of severe neutropenia", "correct": false}], "correct_answer": "C. It should not be administered in sickle cell patients", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C: Pegylated-filgrastim should not be administered in sickle cell patients.\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most effective treatment for idiopathic thrombocytopenic purpura among the options provided?", "options": [{"label": "A", "text": "IV immunoglobulins", "correct": false}, {"label": "B", "text": "Steroids", "correct": false}, {"label": "C", "text": "Splenectomy", "correct": true}, {"label": "D", "text": "Blood transfusion", "correct": false}], "correct_answer": "C. Splenectomy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C- S\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The best approach in the treatment of chronic SIADH is _____________:", "options": [{"label": "A", "text": "Tolvaptan", "correct": true}, {"label": "B", "text": "Reducing fluid intake to &amp;lt;500 ml per day", "correct": false}, {"label": "C", "text": "Demeclocycline", "correct": false}, {"label": "D", "text": "Fludrocortisone", "correct": false}], "correct_answer": "A. Tolvaptan", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Tolv\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which cardiac chamber enlargement is seen in the case of mitral stenosis on chest x-ray initially ?", "options": [{"label": "A", "text": "Left atrium", "correct": true}, {"label": "B", "text": "Right atrium", "correct": false}, {"label": "C", "text": "Left ventricle", "correct": false}, {"label": "D", "text": "Right ventricle", "correct": false}], "correct_answer": "A. Left atrium", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Left atriu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Intravenous mannitol is used in ____________?", "options": [{"label": "A", "text": "Pulmonary edema", "correct": false}, {"label": "B", "text": "Congestive cardiac failure", "correct": false}, {"label": "C", "text": "Acute kidney injury with anuria", "correct": false}, {"label": "D", "text": "Glaucoma", "correct": true}], "correct_answer": "D. Glaucoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Glau\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following carbapenems has increased risk of causing seizures ?", "options": [{"label": "A", "text": "Meropenem", "correct": false}, {"label": "B", "text": "Imipenem", "correct": true}, {"label": "C", "text": "Etrapenem", "correct": false}, {"label": "D", "text": "Doripenem", "correct": false}], "correct_answer": "B. Imipenem", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - I\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which among the following is incorrect?", "options": [{"label": "A", "text": "Components of MELD (model for end stage liver disease) scoring system are creatinine, bilirubin, international normalized ratio (INR), serum sodium (mEq/L)", "correct": false}, {"label": "B", "text": "Components of CTP (Child Turcotte Pugh) score are albumin, bilirubin, INR, ascites and encephalopathy", "correct": false}, {"label": "C", "text": "Components of CTP (child Turcotte Pugh) are creatinine, bilirubin, international normalized ratio (INR)", "correct": true}, {"label": "D", "text": "MELD score is used to assess and prioritize patients awaiting liver transplantation", "correct": false}], "correct_answer": "C. Components of CTP (child Turcotte Pugh) are creatinine, bilirubin, international normalized ratio (INR)", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following helps in maintaining the patency of ductus arteriosus ?", "options": [{"label": "A", "text": "PGF2α", "correct": false}, {"label": "B", "text": "PGE1", "correct": true}, {"label": "C", "text": "PGH2", "correct": false}, {"label": "D", "text": "PGI2", "correct": false}], "correct_answer": "B. PGE1", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - PGE\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Prostaglandin Analogue</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Uses</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Prostaglandin E1 (PGE1)</strong></p>\n</td>\n<td>\n<p>Used to maintain the <span class=\"customMeta\" data-dictid=\"8c660f0c321692777194046901e354\">patency</span> of the <span class=\"customMeta\" data-dictid=\"7a6864e97b169277718602072817ee\">ductus</span> arteriosus in specific clinical situations, such as newborns with critical <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> heart defects.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Prostaglandin F2α (PGF2α)</strong></p>\n</td>\n<td>\n<p> Has various <span class=\"customMeta\" data-dictid=\"8dfaeedbf91692777200561b2b1d2f\">therapeutic</span> applications, such as <span class=\"customMeta\" data-dictid=\"f447020b9616927771904d1c923d80\">induction</span> of labor or treatment of glaucoma.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Prostacyclin (PGI2)</strong></p>\n</td>\n<td>\n<p> Has therapeutic applications such as treatment of <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> hypertension. Also has <span class=\"customMeta\" data-dictid=\"4665fdd0a0169277718100f58eb0d5\">anti</span> <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">platelet</span> effect.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Please select the incorrect statement regarding the bundle of Kent.", "options": [{"label": "A", "text": "It is faster than AV nodal pathway", "correct": false}, {"label": "B", "text": "It is slower than AV nodal pathway", "correct": true}, {"label": "C", "text": "Leads to short PR interval", "correct": false}, {"label": "D", "text": "Leads to prolonged QRS duration", "correct": false}], "correct_answer": "B. It is slower than AV nodal pathway", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - It is slower than AV nodal path\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Osborn waves in ECG are seen in:", "options": [{"label": "A", "text": "Hypothyroidism", "correct": false}, {"label": "B", "text": "Hypothermia", "correct": true}, {"label": "C", "text": "Hypocalcaemia", "correct": false}, {"label": "D", "text": "Hypokalaemia", "correct": false}], "correct_answer": "B. Hypothermia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Hypoth\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In obesity, there is an increase in the production of which of the following hormones?", "options": [{"label": "A", "text": "Insulin", "correct": true}, {"label": "B", "text": "Thyroxine", "correct": false}, {"label": "C", "text": "Growth hormone", "correct": false}, {"label": "D", "text": "Adiponectin", "correct": false}], "correct_answer": "A. Insulin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Insu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the diagnosis of this patient from the ECG shown below?", "options": [{"label": "A", "text": "Normal ECG", "correct": false}, {"label": "B", "text": "Ventricular fibrillation", "correct": false}, {"label": "C", "text": "Ventricular tachycardia", "correct": true}, {"label": "D", "text": "Misplaced leads", "correct": false}], "correct_answer": "C. Ventricular tachycardia", "question_images": ["https://image.prepladder.com/content/JcIrxjsBMCStqozUFi8Q1691501994.png"], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\"&gt;Ventricular&lt;/span&gt; tach\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Ventricular Arrhythmia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>ECG Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ventricular Tachycardia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Wide QRS complex (&gt;0.12 seconds)</li>\n</ul>\n<ul>\n<li>Absence of P waves or dissociated P waves</li>\n</ul>\n<ul>\n<li>Regular or slightly <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> rhythm</li>\n</ul>\n<ul>\n<li>Monomorphic (consistent QRS morphology) or <span class=\"customMeta\" data-dictid=\"61bad3c5dc1692777196997698f068\">polymorphic</span> (varying QRS morphology)</li>\n</ul>\n<ul>\n<li>Ventricular rate typically between 100-250 bpm</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ventricular Fibrillation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Chaotic and <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> rhythm</li>\n</ul>\n<ul>\n<li>Rapid, irregular, and uncoordinated QRS complexes</li>\n</ul>\n<ul>\n<li>Absence of identifiable P waves</li>\n</ul>\n<ul>\n<li>Absence of clear T waves</li>\n</ul>\n<ul>\n<li>\"Quivering\" or \"fine to coarse\" fibrillatory waves seen throughout the ECG</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following criteria would you utilize to evaluate the effectiveness of the malaria surveillance system implemented by the National Vector Borne Disease Control Programme?", "options": [{"label": "A", "text": "Annual Parasite Index", "correct": false}, {"label": "B", "text": "Annual Blood Examination Rate", "correct": true}, {"label": "C", "text": "Slide positivity rate", "correct": false}, {"label": "D", "text": "Slide falciparum rate", "correct": false}], "correct_answer": "B. Annual Blood Examination Rate", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Parameter</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Definition</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Purpose/Use</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Annual <span class=\"customMeta\" data-dictid=\"a59b97ce831692777194f6c0160f15\">Parasite</span> Index (API)</p>\n</td>\n<td>\n<p>Number of confirmed <span class=\"customMeta\" data-dictid=\"8b4c650ddd1692777191286afbcd8a\">malaria</span> cases per 1,000 population in a specific area within a year</p>\n</td>\n<td>\n<p>Measures the <span class=\"customMeta\" data-dictid=\"17cd3771bb1692777190950c142dbe\">incidence</span> or burden of <span class=\"customMeta\" data-dictid=\"8b4c650ddd1692777191286afbcd8a\">malaria</span> in a population</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Annual Blood Examination Rate (ABER)</p>\n</td>\n<td>\n<p>Percentage of the population at risk of <span class=\"customMeta\" data-dictid=\"8b4c650ddd1692777191286afbcd8a\">malaria</span> who have undergone blood examination for <span class=\"customMeta\" data-dictid=\"8b4c650ddd1692777191286afbcd8a\">malaria</span> parasites</p>\n</td>\n<td>\n<p>Assesses the coverage and efficiency of the surveillance system in terms of <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> testing for malaria</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Slide Positivity Rate (SPR)</p>\n</td>\n<td>\n<p>Percentage of blood slides examined that test positive for <span class=\"customMeta\" data-dictid=\"8b4c650ddd1692777191286afbcd8a\">malaria</span> parasites</p>\n</td>\n<td>\n<p>Provides information about the proportion of individuals tested who have confirmed <span class=\"customMeta\" data-dictid=\"8b4c650ddd1692777191286afbcd8a\">malaria</span> infection</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Slide Falciparum Rate (SFR)</p>\n</td>\n<td>\n<p>Percentage of blood slides examined that test positive for <span class=\"customMeta\" data-dictid=\"adb1d6aae2169277719562770dd578\">Plasmodium</span> falciparum</p>\n</td>\n<td>\n<p>Focuses on the <span class=\"customMeta\" data-dictid=\"f86aae0bd61692777196f91458c9dd\">prevalence</span> of P. falciparum infection among tested individuals</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is false regarding patients with trigeminal neuralgia?", "options": [{"label": "A", "text": "More common in females", "correct": false}, {"label": "B", "text": "Pain along V2 and V3 division of trigeminal nerve", "correct": false}, {"label": "C", "text": "Deep seated pain", "correct": true}, {"label": "D", "text": "No objective signs of sensory loss", "correct": false}], "correct_answer": "C. Deep seated pain", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Deep-seated P\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is incorrect in relation to confounding factors?", "options": [{"label": "A", "text": "It can be reduced by matching", "correct": false}, {"label": "B", "text": "It is associated individually with both cause and effect", "correct": false}, {"label": "C", "text": "It is distributed equally in both study and control groups", "correct": true}, {"label": "D", "text": "It is associated with the exposure of the study", "correct": false}], "correct_answer": "C. It is distributed equally in both study and control groups", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - It is distributed equally in both study and control grou\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/aoIB5rINUDzzJ9wa5guA1746258329.mp3", "video": ""}, {"text": "Which of the following is the best level of prevention of breast cancer?", "options": [{"label": "A", "text": "Specific protection", "correct": false}, {"label": "B", "text": "Early diagnosis and treatment", "correct": true}, {"label": "C", "text": "Disability limitation", "correct": false}, {"label": "D", "text": "Rehabilitation", "correct": false}], "correct_answer": "B. Early diagnosis and treatment", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Early Diagnosis and T\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the dosage of vitamin A given for a 2-year-old baby with keratomalacia?", "options": [{"label": "A", "text": "2,00,000 IU immediately, followed by same dose after 24 hours", "correct": false}, {"label": "B", "text": "1,00,000 IU immediately, followed by the same dose after 1 week", "correct": false}, {"label": "C", "text": "1,00,000 IU immediately, followed by the same dose after 24 hours and after a week", "correct": false}, {"label": "D", "text": "2,00,000 IU immediately, followed by the same dose 24 hours later and after 2 weeks", "correct": true}], "correct_answer": "D. 2,00,000 IU immediately, followed by the same dose 24 hours later and after 2 weeks", "question_images": [], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Age Group</strong></p>\n</td>\n<td>\n<p><strong>Recommended <span class=\"customMeta\" data-dictid=\"4941f0477a1692777202923cd79e22\">Vitamin A</span> Dose</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>6-11 months</p>\n</td>\n<td>\n<p>100,000 IU</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>12-59 months</p>\n</td>\n<td>\n<p>200,000 IU</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>5-12 years</p>\n</td>\n<td>\n<p>200,000 IU</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>13 years and above</p>\n</td>\n<td>\n<p>500,000 IU</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What percentage of distribution is represented by one standard deviation in a normal curve?", "options": [{"label": "A", "text": "68%", "correct": true}, {"label": "B", "text": "34%", "correct": false}, {"label": "C", "text": "99%", "correct": false}, {"label": "D", "text": "95%", "correct": false}], "correct_answer": "A. 68%", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "As per IMNCI guidelines, a diagnosis of pneumonia is made in a 6-month-old infant when the child exhibits rapid breathing with a respiratory rate exceeding:", "options": [{"label": "A", "text": "40", "correct": false}, {"label": "B", "text": "60", "correct": false}, {"label": "C", "text": "30", "correct": false}, {"label": "D", "text": "50", "correct": true}], "correct_answer": "D. 50", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - 5\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following items is included in the concurrent list of the Indian Constitution?", "options": [{"label": "A", "text": "Adulteration of food", "correct": true}, {"label": "B", "text": "Fishing and fisheries beyond territorial waters", "correct": false}, {"label": "C", "text": "Regulating labor in mines", "correct": false}, {"label": "D", "text": "Public health and sanitation", "correct": false}], "correct_answer": "A. Adulteration of food", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A- &lt;span class=\"customMeta\" data-dictid=\"419d4d63611692777180fa22cd0151\"&gt;Adulteration&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Except for which of the following, all the mentioned characteristics are associated with Crohn's disease?", "options": [{"label": "A", "text": "Transmural involvement", "correct": false}, {"label": "B", "text": "Lead pipe appearance", "correct": true}, {"label": "C", "text": "Rectal sparing", "correct": false}, {"label": "D", "text": "Perianal fistula", "correct": false}], "correct_answer": "B. Lead pipe appearance", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - L\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Feature</strong></p>\n</td>\n<td>\n<p><strong>Crohn's Disease</strong></p>\n</td>\n<td>\n<p><strong>Ulcerative Colitis</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Location</p>\n</td>\n<td>\n<p>Can occur anywhere in the <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> tract</p>\n</td>\n<td>\n<p>Primarily affects the <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> and rectum</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Inflammation pattern</p>\n</td>\n<td>\n<p>Patchy, <span class=\"customMeta\" data-dictid=\"53ab411c811692777200e0e1b68984\">transmural</span> inflammation</p>\n</td>\n<td>\n<p>Continuous, <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> inflammation</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Depth of involvement</p>\n</td>\n<td>\n<p>Transmural (involves all layers of the intestinal wall)</p>\n</td>\n<td>\n<p>Mucosal and <span class=\"customMeta\" data-dictid=\"7cb424e4921692777199f9951be2ce\">submucosal</span> (inner layers of the colon)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Distribution</p>\n</td>\n<td>\n<p>Skip lesions (segments of involved and non-involved areas)</p>\n</td>\n<td>\n<p>Continuous involvement, starting from rectum</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Rectal involvement</p>\n</td>\n<td>\n<p>Often involved but can be spared (rectal sparing)</p>\n</td>\n<td>\n<p>Commonly involved, extending proximally</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Perianal complications</p>\n</td>\n<td>\n<p>Fistulas, abscesses, fissures</p>\n</td>\n<td>\n<p>Less common</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Gross appearance of mucosa</p>\n</td>\n<td>\n<p>Cobblestone appearance, strictures, ulcerations</p>\n</td>\n<td>\n<p>Continuous inflammation, pseudopolyps</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Complications</p>\n</td>\n<td>\n<p>Strictures, fistulas, abscesses, <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> obstruction</p>\n</td>\n<td>\n<p>Toxic megacolon, <span class=\"customMeta\" data-dictid=\"f04bf2125316927771847bfe139191\">colorectal</span> cancer risk</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most frequently observed form of Guillain-Barre syndrome among the options provided?", "options": [{"label": "A", "text": "Acute motor axonal neuropathy", "correct": false}, {"label": "B", "text": "Acute inflammatory demyelinating polyneuropathy", "correct": true}, {"label": "C", "text": "Acute motor sensory axonal neuropathy", "correct": false}, {"label": "D", "text": "Miller fisher syndrome", "correct": false}], "correct_answer": "B. Acute inflammatory demyelinating polyneuropathy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\"&gt;Acute&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\"&gt;inflammatory&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"25cf8215eb1692777186f0ab76dc34\"&gt;demyelinating polyneuropathy&lt;/span&gt; (AIDP)\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old patient was brought to the OPD with complains of fatigability, vomiting, and malaise. Examination revealed occult blood in stools, anemia, and hypertension. The patient was diagnosed to have cushing’s ulcers. What could be the likely reason for cushion’s ulcer?", "options": [{"label": "A", "text": "Burns", "correct": false}, {"label": "B", "text": "Stress", "correct": false}, {"label": "C", "text": "Head injury", "correct": true}, {"label": "D", "text": "Cell necrosis", "correct": false}], "correct_answer": "C. Head injury", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Head inju\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Named Ulcer</strong></p>\n</td>\n<td>\n<p><strong>Associated Cause(s)</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Cushing's Ulcers</p>\n</td>\n<td>\n<p>Severe head injury and increased <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> pressure</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Curling's Ulcers</p>\n</td>\n<td>\n<p>Severe burns and extensive tissue injury</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Stress Ulcers</p>\n</td>\n<td>\n<p>Severe illness, trauma, surgery, critical illness</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Ischemic Ulcers</p>\n</td>\n<td>\n<p>Impaired blood supply to the <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> tract</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Dieulafoy's Ulcer</p>\n</td>\n<td>\n<p>Abnormally large <span class=\"customMeta\" data-dictid=\"4632fe89141692777200f671693e55\">tortuous</span> <span class=\"customMeta\" data-dictid=\"7cb424e4921692777199f9951be2ce\">submucosal</span> artery</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Cameron Ulcers</p>\n</td>\n<td>\n<p>Hiatal <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> and chronic iron <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> anemia</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which statement is accurate regarding paroxysmal nocturnal hemoglobinuria (PNH)?", "options": [{"label": "A", "text": "Inherited defect in PIG-A", "correct": false}, {"label": "B", "text": "Extravascular haemolysis", "correct": false}, {"label": "C", "text": "Deficiency of CD 55 and CD 59", "correct": true}, {"label": "D", "text": "Microcytic anaemia", "correct": false}], "correct_answer": "C. Deficiency of CD 55 and CD 59", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\"&gt;Deficiency&lt;/span&gt; of CD55 and CD59\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with rheumatoid arthritis has been treated with methotrexate and low-dose corticosteroids for the past 4 months . However, the disease is still progressing. What would be your recommendation for the further management of this patient?", "options": [{"label": "A", "text": "Stop oral methotrexate and start parenteral methotrexate", "correct": false}, {"label": "B", "text": "Add sulfasalazine and hydroxychloroquine", "correct": true}, {"label": "C", "text": "Continue corticosteroids and methotrexate", "correct": false}, {"label": "D", "text": "Start only anti-TNF alpha agents", "correct": false}], "correct_answer": "B. Add sulfasalazine and hydroxychloroquine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Add &lt;span class=\"customMeta\" data-dictid=\"25673e79721692777199949b9db072\"&gt;sulfasalazine&lt;/span&gt; and hydroxychloroqu\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Conventional DMARDs</strong></p>\n</td>\n<td>\n<p>Methotrexate, Sulfasalazine, Hydroxychloroquine</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Biological DMARDs</strong></p>\n</td>\n<td>\n<p>Tumor <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">Necrosis</span> Factor (TNF) Inhibitors (e.g., Adalimumab, Etanercept, Infliximab), <span class=\"customMeta\" data-dictid=\"cc29a6414e169277719052a6df813f\">Interleukin-6</span> (IL-6) Inhibitors (e.g., Tocilizumab), B-cell Modulators (e.g., Rituximab), T-cell Co-stimulation Blockers (e.g., Abatacept), <span class=\"customMeta\" data-dictid=\"859f9b3ad916927771909475f4445b\">Janus Kinase</span> (JAK) Inhibitors (e.g., Baricitinib, Tofacitinib)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Targeted <span class=\"customMeta\" data-dictid=\"61fbe2173416927771998e7aa0b432\">Synthetic</span> DMARDs</strong></p>\n</td>\n<td>\n<p>Janus <span class=\"customMeta\" data-dictid=\"9863da498e1692777190e1c6515b48\">Kinase</span> (JAK) Inhibitors (e.g., Baricitinib, Tofacitinib)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Other DMARDs</strong></p>\n</td>\n<td>\n<p>Leflunomide, Cyclosporine, Azathioprine</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A f emale patient presents with fever, oral ulcer, photosensitivity, and rashes on her face as shown below . What is the most likely diagnosis ?", "options": [{"label": "A", "text": "Dermatomyositis", "correct": false}, {"label": "B", "text": "Systemic lupus erythematosus", "correct": true}, {"label": "C", "text": "Rosacea", "correct": false}, {"label": "D", "text": "Melasma", "correct": false}], "correct_answer": "B. Systemic lupus erythematosus", "question_images": ["https://image.prepladder.com/content/WrvFZboupV3v84L6UNso1712315857.png"], "explanation_images": [], "explanation": "<p>Correct Option B - Systemic &lt;span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\"&gt;lupus&lt;/span&gt; erythematosu\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Cutaneous Manifestations of SLE</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Butterfly <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">Rash</span> (Malar Rash)</p>\n</td>\n<td>\n<p>Red or erythematous <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> over the cheeks and <span class=\"customMeta\" data-dictid=\"a57b5419551692777183ef6e7bbb14\">bridge of the nose</span> in a butterfly pattern <span class=\"customMeta\" data-dictid=\"a57b5419551692777183ef6e7bbb14\">bridge of the nose</span> in a butterfly pattern</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Discoid Rash</p>\n</td>\n<td>\n<p>Round or oval-shaped red plaques with <span class=\"customMeta\" data-dictid=\"3eae9d3a481692777198158ddc37bc\">scaling</span> and scarring, commonly on the face, scalp, and ears</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Photosensitivity</p>\n</td>\n<td>\n<p>Increased sensitivity to sunlight, resulting in a <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> or worsening of existing skin lesions</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Oral Ulcers</p>\n</td>\n<td>\n<p>Painful, shallow ulcers in the mouth or nose typically without scarring</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Subacute <span class=\"customMeta\" data-dictid=\"94f1c8df1f1692777185bd6a7c3fff\">Cutaneous</span> <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">Lupus</span> Erythematosus (SCLE)</p>\n</td>\n<td>\n<p>Red, scaly, and <span class=\"customMeta\" data-dictid=\"96f5104d6816927771816ac8dfceeb\">annular</span> (ring-shaped) lesions that may develop a more defined border with central clearing</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Raynaud's Phenomenon</p>\n</td>\n<td>\n<p>Intermittent color changes in the fingers or toes, often <span class=\"customMeta\" data-dictid=\"3978e9614f1692777200abbe4cfa34\">triggered</span> by cold or stress</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Alopecia</p>\n</td>\n<td>\n<p>Hair loss, which can be patchy or diffuse(may not result in complete baldness)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Vasculitis</p>\n</td>\n<td>\n<p>Inflammation of blood vessels resulting in skin rashes, ulcers, or necrosis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following murmur increases on standing?", "options": [{"label": "A", "text": "HOCM", "correct": true}, {"label": "B", "text": "MR", "correct": false}, {"label": "C", "text": "MS", "correct": false}, {"label": "D", "text": "VSD", "correct": false}], "correct_answer": "A. HOCM", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"3263e0795416927771895e5410c988\"&gt;HOCM&lt;/span&gt; (Hypertrophic Obstructive Cardiomyopathy)\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "On performing a pulmonary function test, reduction in FEV1/FVC is characteristic of:", "options": [{"label": "A", "text": "Restrictive disease", "correct": false}, {"label": "B", "text": "Obstructive disease", "correct": true}, {"label": "C", "text": "Normal lung function", "correct": false}, {"label": "D", "text": "Interstitial lung disease", "correct": false}], "correct_answer": "B. Obstructive disease", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Obstructiv\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Parameter</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Forced <span class=\"customMeta\" data-dictid=\"632c0c215816927771878b6e818a11\">Expiratory</span> Volume in 1 second (FEV1)</p>\n</td>\n<td>\n<p>Decreased</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Forced <span class=\"customMeta\" data-dictid=\"187bb6b3f61692777201956c59ce72\">Vital Capacity</span> (FVC)</p>\n</td>\n<td>\n<p>Decreased (may be normal or slightly decreased)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>FEV1/FVC Ratio</p>\n</td>\n<td>\n<p>Decreased</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Peak <span class=\"customMeta\" data-dictid=\"632c0c215816927771878b6e818a11\">Expiratory</span> Flow Rate (PEFR)</p>\n</td>\n<td>\n<p>Decreased</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Total Lung Capacity (TLC)</p>\n</td>\n<td>\n<p>Normal or increased</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Residual Volume (RV)</p>\n</td>\n<td>\n<p>Increased</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Functional <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">Residual</span> Capacity (FRC)</p>\n</td>\n<td>\n<p>Increased</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Tidal Volume (TV)</p>\n</td>\n<td>\n<p>Normal or slightly decreased</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 42-year-old patient presents with complaints of bone pain in the hands, difficulty in passing stools, along with history of recurrent renal stones. On investigation, his serum calcium was increased, decreased serum phosphate and X-ray showing subperiosteal resorption of phalanges. In which of the following conditions calcitonin levels are increased?", "options": [{"label": "A", "text": "Hyperthyroidism", "correct": false}, {"label": "B", "text": "Hypoparathyroidism", "correct": false}, {"label": "C", "text": "Hyperparathyroidism", "correct": true}, {"label": "D", "text": "Cushing’s syndrome", "correct": false}], "correct_answer": "C. Hyperparathyroidism", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Hyperparath\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Hormonal Levels</strong></p>\n</td>\n<td>\n<p><strong>Hyperparathyroidism</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Parathyroid Hormone (PTH)</p>\n</td>\n<td>\n<p>Increased</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Calcium (serum)</p>\n</td>\n<td>\n<p>Increased</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Phosphate (serum)</p>\n</td>\n<td>\n<p>Decreased or normal</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Calcitonin</p>\n</td>\n<td>\n<p>May be increased in some cases, but not a <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> marker for hyperparathyroidism</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which one of the following is a direct cause of Acute Respiratory Distress Syndrome (ARDS)?", "options": [{"label": "A", "text": "Pneumonia", "correct": true}, {"label": "B", "text": "Fat embolism syndrome following femur shaft fracture", "correct": false}, {"label": "C", "text": "Sepsis", "correct": false}, {"label": "D", "text": "Transfusion-related lung injury", "correct": false}], "correct_answer": "A. Pneumonia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Pneu\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Causes of Direct Injury (Air-Lung Interface)</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Causes of <span class=\"customMeta\" data-dictid=\"2f73e160ba1692777190d65065c95b\">Indirect</span> Injury (Blood-Lung Interface)</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Inhalation of toxic gases and chemicals</p>\n</td>\n<td>\n<p>Sepsis</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Aspiration of <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> contents</p>\n</td>\n<td>\n<p>Fat <span class=\"customMeta\" data-dictid=\"1c07a1135f1692777187f547678386\">embolism</span> syndrome</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Near-drowning</p>\n</td>\n<td>\n<p>Transfusion-related lung injury</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>High-pressure mechanical ventilation</p>\n</td>\n<td>\n<p>Pancreatitis</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Radiation therapy</p>\n</td>\n<td>\n<p>Drug-induced lung injury</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Inhalation of smoke or <span class=\"customMeta\" data-dictid=\"d4226a4b2e169277719459bb9339d6\">particulate</span> matter</p>\n</td>\n<td>\n<p>Systemic <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">lupus</span> erythematosus (SLE)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Acute <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"afafb9026e1692777186e3dd168fa8\">distress</span> syndrome (ARDS)</p>\n</td>\n<td>\n<p>Connective tissue diseases (e.g., <span class=\"customMeta\" data-dictid=\"40dbde72e41692777197e59d893839\">rheumatoid</span> arthritis, scleroderma)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Pneumonia (severe cases)</p>\n</td>\n<td>\n<p>Cardiogenic <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> edema</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Chemical pneumonitis</p>\n</td>\n<td>\n<p>Near-drowning</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Inhalation of harmful fumes (e.g., <span class=\"customMeta\" data-dictid=\"3c268a141b1692777184336bc40100\">chlorine</span> gas)</p>\n</td>\n<td>\n<p>Inhalation of harmful fumes (e.g., <span class=\"customMeta\" data-dictid=\"3c268a141b1692777184336bc40100\">chlorine</span> gas)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 4-year-old male child developed with sore throat, difficulty in swallowing, and mild fever . On examination, the clinical picture shown below is seen. Which of the following sentences is false regarding the vaccine that could have prevented this condition?", "options": [{"label": "A", "text": "It is administered on the anterolateral aspect of the thigh.", "correct": false}, {"label": "B", "text": "A history of anaphylaxis with same vaccine is not a contraindication", "correct": true}, {"label": "C", "text": "The cellular pertussis component in the vaccine is not recommended after 7-years of age", "correct": false}, {"label": "D", "text": "The diphtheria toxoid dose in adults is much lesser than the pediatric dose", "correct": false}], "correct_answer": "B. A history of anaphylaxis with same vaccine is not a contraindication", "question_images": ["https://image.prepladder.com/content/qUcNwLR3zl8zbmbJ3H5c1691506490.png"], "explanation_images": [], "explanation": "<p>Correct Option B - A history of &lt;span class=\"customMeta\" data-dictid=\"d6d717efa216927771819fee139235\"&gt;anaphylaxis&lt;/span&gt; with the same v\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the main unit of administration in India called?", "options": [{"label": "A", "text": "Village", "correct": false}, {"label": "B", "text": "Centre", "correct": false}, {"label": "C", "text": "District", "correct": true}, {"label": "D", "text": "State", "correct": false}], "correct_answer": "C. District", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Principal Unit of Administration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Village</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Villages are the basic units of rural administration in India. Several villages together <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> a larger administrative unit known as a block or tehsil.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>District</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Districts are the principal units of administration in India.. <strong>Districts are further divided into smaller administrative units such as sub-districts (tehsils) or taluks, which comprise multiple villages.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>State</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>States in India have their own elected governments and legislatures.<strong>.</strong> States consist of multiple districts, and each district has its own administration under the state government.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Centre</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"1feb2a0a3016927771847db9449f75\">Centre</span> refers to the <strong>Central Government of India, which is the highest level of administration in the country.</strong> The <span class=\"customMeta\" data-dictid=\"1feb2a0a3016927771847db9449f75\">Centre</span> interacts with the states and provides guidance and support in various areas, but it does not directly administer local units.</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Cross product ratio can be arrived from:", "options": [{"label": "A", "text": "Ecological study", "correct": false}, {"label": "B", "text": "Cohort study", "correct": false}, {"label": "C", "text": "Cross sectional study", "correct": false}, {"label": "D", "text": "Case control study", "correct": true}], "correct_answer": "D. Case control study", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Case-control stu\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Outcome Present (Cases)</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>Outcome Absent (Controls)</strong></p>\n</td>\n<td>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\">Exposed</p>\n</td>\n<td>\n<p style=\"text-align: center;\">a</p>\n</td>\n<td>\n<p style=\"text-align: center;\">b</p>\n</td>\n</tr>\n<tr>\n<td>\n<p style=\"text-align: center;\">Unexposed</p>\n</td>\n<td>\n<p style=\"text-align: center;\">c</p>\n</td>\n<td>\n<p style=\"text-align: center;\">d</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/XFv9sZvoCjkoXVKb85sq1746258810.mp3", "video": ""}, {"text": "What is the minimum amount of land needed for the trench method to be applied in controlled tipping for a population of 10,000?", "options": [{"label": "A", "text": "4 acres", "correct": false}, {"label": "B", "text": "5 acres", "correct": false}, {"label": "C", "text": "2 acres", "correct": false}, {"label": "D", "text": "1 acre", "correct": true}], "correct_answer": "D. 1 acre", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/FgZTnmqg2ksT4x5E1zvg1713767826.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the preferred test for evaluating the disparity in means between two groups in a study, where one group serves as the control?", "options": [{"label": "A", "text": "Chi-square test", "correct": false}, {"label": "B", "text": "Z test", "correct": false}, {"label": "C", "text": "Unpaired T test", "correct": true}, {"label": "D", "text": "Paired T test", "correct": false}], "correct_answer": "C. Unpaired T test", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C-Unpaired T\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the purpose of conducting a significance test for two or more proportions?", "options": [{"label": "A", "text": "Chi- square test", "correct": true}, {"label": "B", "text": "Student's test", "correct": false}, {"label": "C", "text": "Z test", "correct": false}, {"label": "D", "text": "ANOVA test", "correct": false}], "correct_answer": "A. Chi- square test", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A-Chi-squ\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "If a patient tests positive for a disease, which of the following represents the probability of her actually having the disease?", "options": [{"label": "A", "text": "Sensitivity", "correct": false}, {"label": "B", "text": "Specificity", "correct": false}, {"label": "C", "text": "Positive predictive value", "correct": true}, {"label": "D", "text": "Negative predictive value", "correct": false}], "correct_answer": "C. Positive predictive value", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"6ec8c6811e1692777196da36a72ad6\"&gt;Positive predictive value&lt;/span&gt; (PPV)\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Measure</strong></p>\n</td>\n<td>\n<p><strong>Formula</strong></p>\n</td>\n<td>\n<p><strong>Definition</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Sensitivity</p>\n</td>\n<td>\n<p>Sensitivity = TP / (TP + FN)</p>\n</td>\n<td>\n<p>Sensitivity, also known as the true positive rate or recall, is the proportion of true positives (TP) correctly identified by a <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> test. It indicates the ability of the test to correctly identify individuals who have the disease or condition.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Specificity</p>\n</td>\n<td>\n<p>Specificity = TN / (TN + FP)</p>\n</td>\n<td>\n<p>Specificity is the proportion of true negatives (TN) correctly identified by a <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> test. It represents the ability of the test to correctly identify individuals who do not have the disease or condition.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Positive <span class=\"customMeta\" data-dictid=\"758b4503bf1692777196b4872a0e36\">Predictive Value</span> (PPV)</p>\n</td>\n<td>\n<p>PPV = TP / (TP + FP)</p>\n</td>\n<td>\n<p>PPV, also known as precision, is the proportion of true positives (TP) out of all positive test results (TP + FP). It represents the <span class=\"customMeta\" data-dictid=\"f52ac1410416927771969ba21fcb63\">probability</span> that a person has the disease or condition given a positive test result.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Negative <span class=\"customMeta\" data-dictid=\"758b4503bf1692777196b4872a0e36\">Predictive Value</span> (NPV)</p>\n</td>\n<td>\n<p>NPV = TN / (TN + FN)</p>\n</td>\n<td>\n<p>NPV is the proportion of true negatives (TN) out of all negative test results (TN + FN). It represents the <span class=\"customMeta\" data-dictid=\"f52ac1410416927771969ba21fcb63\">probability</span> that a person does not have the disease or condition given a negative test result.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which statistical diagram represents the population change in a specific location from 1983 to 1989?", "options": [{"label": "A", "text": "Histogram", "correct": false}, {"label": "B", "text": "Line diagram", "correct": false}, {"label": "C", "text": "Component bar graph", "correct": true}, {"label": "D", "text": "Multiple bar graphs", "correct": false}], "correct_answer": "C. Component bar graph", "question_images": ["https://image.prepladder.com/content/u5xNjBrYkpQcJSk7ryzp1687849466.png"], "explanation_images": [], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p><strong>Graphical Representation</strong></p>\n</td>\n<td>\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Line Graph</p>\n</td>\n<td>\n<p>Displays data points connected by straight lines to show trends over time or continuous variables.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Bar Graph</p>\n</td>\n<td>\n<p>Uses bars of equal <span class=\"customMeta\" data-dictid=\"1b0d31fe811692777202644090ba60\">width</span> to represent categorical data or compare values across different categories.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Pie Chart</p>\n</td>\n<td>\n<p>Represents parts of a whole using sectors of a circle, showing the proportion of each category.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Histogram</p>\n</td>\n<td>\n<p>Displays the distribution of continuous or grouped data by using bars of varying heights to represent the frequency or <span class=\"customMeta\" data-dictid=\"e73edb66b516927771976bebf5a2f2\">relative frequency</span> of data within specific ranges or bins.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Area Chart</p>\n</td>\n<td>\n<p>Similar to a line <span class=\"customMeta\" data-dictid=\"90b63cdcfe16927771885e9612aecb\">graph</span> but with the area under the line filled, used to represent accumulated totals or proportions over time.</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During disaster management, triage is implemented to ensure that casualties receive appropriate treatment. Which statement accurately describes the triage process conducted at the disaster site?", "options": [{"label": "A", "text": "First come first treated basis", "correct": false}, {"label": "B", "text": "Green labels are for those who need to be transported on priority", "correct": false}, {"label": "C", "text": "Moribund patients receive the lowest priority", "correct": true}, {"label": "D", "text": "Most commonly used system is three color code system", "correct": false}], "correct_answer": "C. Moribund patients receive the lowest priority", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C-Moribund patients receive th\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Red</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>High priority</strong></li>\n<li><strong>Victims must be helped within 0 to 6 hours.</strong></li>\n<li><strong>Require immediate <span class=\"customMeta\" data-dictid=\"d343b06c7f1692777197edaea107af\">resuscitation</span> or life-saving surgery.</strong></li>\n<li><strong>E.g.- <span class=\"customMeta\" data-dictid=\"23f9f85a721692777188a3706ea1cb\">hemothorax</span> or pneumothorax</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Yellow or Blue</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Medium priority</strong></li>\n<li><strong>Victims must be helped within 6 to 24 hours but can wait up to 24 hours.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Green</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Low priority</strong></li>\n<li><strong>These victims are <span class=\"customMeta\" data-dictid=\"4712037d54169277718165d90f2550\">ambulatory</span> and can move with minor injuries.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Black</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Least priority</strong></li>\n<li><strong>They are either dead or <span class=\"customMeta\" data-dictid=\"f346e30c99169277719253458ef3a0\">moribund</span> (likely to die)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likelihood of genetic diseases occurring in a consanguineous marriage between first cousins?", "options": [{"label": "A", "text": "1-2%", "correct": false}, {"label": "B", "text": "4-8%", "correct": true}, {"label": "C", "text": "8-10%", "correct": false}, {"label": "D", "text": "12-14%", "correct": false}], "correct_answer": "B. 4-8%", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A paradoxical carrier is defined as:", "options": [{"label": "A", "text": "A person who sheds pathogens during incubation period", "correct": false}, {"label": "B", "text": "A carrier who acquired pathogen from another carrier", "correct": true}, {"label": "C", "text": "A person who acquired pathogen from patient", "correct": false}, {"label": "D", "text": "A patient who became a carrier", "correct": false}], "correct_answer": "B. A carrier who acquired pathogen from another carrier", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which vaccine among the options provided is not recommended during pregnancy?", "options": [{"label": "A", "text": "Hepatitis A", "correct": false}, {"label": "B", "text": "Hepatitis B", "correct": false}, {"label": "C", "text": "Rabies", "correct": false}, {"label": "D", "text": "Varicella", "correct": true}], "correct_answer": "D. Varicella", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"cf329b8cef169277720107b1efa15b\"&gt;Varicella&lt;/span&gt; (Chickenpox) v\n<table style=\"width:100%\">\n<tbody>\n<tr>\n<td><strong>Conditions</strong></td>\n<td><strong>Contraindications</strong></td>\n</tr>\n<tr>\n<td>Pregnancy</td>\n<td>\n<ul>\n<li>All live vaccines are contraindicated except yellow fever. </li>\n<li>In India, the yellow fever vaccine is not used due to the required storage temperature.</li>\n<li>Yellow fever is an exotic disease in India.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following options does not qualify as personal protective equipment (PPE)?", "options": [{"label": "A", "text": "Goggles", "correct": false}, {"label": "B", "text": "Gloves", "correct": false}, {"label": "C", "text": "Face shield", "correct": false}, {"label": "D", "text": "Lab coat", "correct": true}], "correct_answer": "D. Lab coat", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - L\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most effective approach to graphically represent the variations in the occurrence of a disease within a specific geographical region throughout a period of time?", "options": [{"label": "A", "text": "Line graph", "correct": true}, {"label": "B", "text": "Histogram", "correct": false}, {"label": "C", "text": "Ogive", "correct": false}, {"label": "D", "text": "Tree diagram", "correct": false}], "correct_answer": "A. Line graph", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/4fkdltiwUjvRJiBXOZdE1714629331.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements regarding Rubella infection is incorrect?", "options": [{"label": "A", "text": "It is a type of droplet infection", "correct": false}, {"label": "B", "text": "Vertical transmission is possible", "correct": false}, {"label": "C", "text": "Infection in early pregnancy causes a milder form of disease in the fetus", "correct": true}, {"label": "D", "text": "Fetus affected in late pregnancy may have only deafness", "correct": false}], "correct_answer": "C. Infection in early pregnancy causes a milder form of disease in the fetus", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What would be the most appropriate course of action to recommend for a resident doctor who has experienced a needlestick injury while collecting blood from an HIV-positive patient, and is now in need of post-exposure prophylaxis ?", "options": [{"label": "A", "text": "Zidovudine + Lamivudine for 4 weeks", "correct": false}, {"label": "B", "text": "Lamivudine + Tenofovir + Efavirenz for 4 weeks", "correct": false}, {"label": "C", "text": "Lamivudine + Tenofovir + Dolutegravir for 4 weeks", "correct": true}, {"label": "D", "text": "Zidovudine + Lamivudine + Nevirapine for 4 weeks", "correct": false}], "correct_answer": "C. Lamivudine + Tenofovir + Dolutegravir for 4 weeks", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Lamivudine + &lt;span class=\"customMeta\" data-dictid=\"8ed4f962f416927772008ece0f551e\"&gt;Tenofovir&lt;/span&gt; + &lt;span class=\"customMeta\" data-dictid=\"ede6d62b71169277718679377f8c24\"&gt;Dolutegravir&lt;/span&gt; for 4 weeks: \n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Please determine the therapeutic index of a medication based on the depicted dose-response curves .:", "options": [{"label": "A", "text": "1", "correct": false}, {"label": "B", "text": "2", "correct": false}, {"label": "C", "text": "4", "correct": true}, {"label": "D", "text": "8", "correct": false}], "correct_answer": "C. 4", "question_images": ["https://image.prepladder.com/content/mibdo1D3IesQQvavXrGH1691506328.png"], "explanation_images": [], "explanation": "<p>Correct Option C - 4\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following nerve passes through the mandibular foramen ?", "options": [{"label": "A", "text": "Lingual nerve", "correct": false}, {"label": "B", "text": "Zygomatic nerve", "correct": false}, {"label": "C", "text": "Chorda tympani nerve", "correct": false}, {"label": "D", "text": "Inferior alveolar nerve", "correct": true}], "correct_answer": "D. Inferior alveolar nerve", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40 year old male patient came to ED with complaints of weakness, paresthesia, and breathing difficulty . Relevant investigations were done. The ECG obtained is suggestive of:", "options": [{"label": "A", "text": "Hypokalaemia", "correct": true}, {"label": "B", "text": "Hyperkalemia", "correct": false}, {"label": "C", "text": "Hypocalcemia", "correct": false}, {"label": "D", "text": "Hypercalcemia", "correct": false}], "correct_answer": "A. Hypokalaemia", "question_images": ["https://image.prepladder.com/content/WE7sxeXNMkMimh6l4Q961694682593.png"], "explanation_images": [], "explanation": "<p>Correct Option A - Hypok\n<table>\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>Hypokalemia Concentration</strong></p>\n</td>\n<td>\n<p style=\"text-align: center;\"><strong>ECG Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Mild (3.0-3.5 mEq/L)</p>\n</td>\n<td>\n<p>T-wave <span class=\"customMeta\" data-dictid=\"13d0edf82916927772021bfc7f9aeb\">flattening</span> or inversion</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Moderate (2.5-3.0 mEq/L)</p>\n</td>\n<td>\n<p>Prominent U waves, <span class=\"customMeta\" data-dictid=\"6b3384701916927771998cea03ba94\">ST segment</span> depression</p>\n</td>\n</tr>\n<tr>\n<td>\n<p>Severe (&lt;2.5 mEq/L)</p>\n</td>\n<td>\n<p>Prolonged QT interval, increased risk of arrhythmias</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is not true about Frey's Syndrome?", "options": [{"label": "A", "text": "Gustatory sweating", "correct": false}, {"label": "B", "text": "Aberrant misdirection of parasympathetic fibers of auriculotemporal nerve", "correct": false}, {"label": "C", "text": "Botulinum toxin is one of the treatment suggested", "correct": false}, {"label": "D", "text": "Less chances with enucleation than paratidectomy", "correct": true}], "correct_answer": "D. Less chances with enucleation than paratidectomy", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60 year old patient presented with Hoarseness of voice. On examination following finding shown below. What could be the diagnosis?", "options": [{"label": "A", "text": "Multinodular goiter", "correct": false}, {"label": "B", "text": "Secondaries neck", "correct": true}, {"label": "C", "text": "TB lymphadenitis", "correct": false}, {"label": "D", "text": "Sternomastoid tumor", "correct": false}], "correct_answer": "B. Secondaries neck", "question_images": ["https://image.prepladder.com/content/UCL2XKZSeLAzJhlwZ82e1713502982.png"], "explanation_images": ["https://image.prepladder.com/content/PxS57sHkXuVZJiyYxJX41713502960.png"], "explanation": "\n<table>\n<tbody>\n<tr>\n<td>\n<p>Metastatic Neck Masses</p>\n</td>\n<td>\n<p>Enlarged <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes due to <span class=\"customMeta\" data-dictid=\"ee33485c641692777192b16b999489\">metastases</span> from primary tumors</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65 year old female patient is brought to the emergency department in a state of unconsciousness . Her BP is 70/50 mm of Hg . Her ECG is shown below . What is the next best step in the management of her condition?", "options": [{"label": "A", "text": "IV verapamil", "correct": false}, {"label": "B", "text": "IV adenosine", "correct": false}, {"label": "C", "text": "Carotid massage", "correct": false}, {"label": "D", "text": "DC cardioversion", "correct": true}], "correct_answer": "D. DC cardioversion", "question_images": ["https://image.prepladder.com/content/U5vD4SW2BIDV5WByoBvp1691755255.png"], "explanation_images": [], "explanation": "<p>Correct Option D - DC cardiov\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 56-year-old male presented with concerns about his eyes bulging and becoming more prominent over the past month. He has previously been diagnosed with Grave's disease. The image below shows the patient's eyes. Based on these findings, what is the most probable diagnosis?", "options": [{"label": "A", "text": "Orbital cellulitis", "correct": false}, {"label": "B", "text": "Preseptal cellulitis", "correct": false}, {"label": "C", "text": "Thyroid eye disease", "correct": true}, {"label": "D", "text": "Capillary hemangioma", "correct": false}], "correct_answer": "C. Thyroid eye disease", "question_images": ["https://image.prepladder.com/content/yvtG9vkBc8pAENDiqIpN1715259659.png"], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\"&gt;Thyroid&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the name of this triangle ?", "options": [{"label": "A", "text": "Gastrinoma triangle", "correct": true}, {"label": "B", "text": "Calot’s triangle", "correct": false}, {"label": "C", "text": "Doom’s triangle", "correct": false}, {"label": "D", "text": "Cholecystohepatic triangle", "correct": false}], "correct_answer": "A. Gastrinoma triangle", "question_images": ["https://image.prepladder.com/content/uWiS9EbIT6rApRYvnzMv1713425504.png"], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"5cdc49fa8b1692777188e3f26ac676\"&gt;Gastrinoma&lt;/span&gt; triang\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 309 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 298 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Which of the following should not be prescribed with theophylline?", "options": [{"label": "A", "text": "Erythromycin", "correct": true}, {"label": "B", "text": "Cefotaxime", "correct": false}, {"label": "C", "text": "Cotrimoxazole", "correct": false}, {"label": "D", "text": "Amoxicillin", "correct": false}], "correct_answer": "A. Erythromycin", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following drugs gets deposited in the cornea?", "options": [{"label": "A", "text": "Leflunomide", "correct": false}, {"label": "B", "text": "Chloroquine", "correct": true}, {"label": "C", "text": "Methotrexate", "correct": false}, {"label": "D", "text": "Salfalazine", "correct": false}], "correct_answer": "B. Chloroquine", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/i550vWBEEtaR9aQbjigF1746435536.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:663px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Chloroquine</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>MOA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Chloroquine accumulates in <span class=\"customMeta\" data-dictid=\"3a983e569716927771805ed22b90d7\">acidic</span> compartments of parasite-infected cells, disrupting <span class=\"customMeta\" data-dictid=\"d4fff554a316927771885dc8700abe\">heme</span> polymerisation and inhibiting <span class=\"customMeta\" data-dictid=\"a59b97ce831692777194f6c0160f15\">parasite</span> growth and replication.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Resistance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Due to mutations in genes <span class=\"customMeta\" data-dictid=\"b989cb3b0d1692777187dd7965b4d3\">encoding</span> transporters involved in <span class=\"customMeta\" data-dictid=\"65d6c8e3de1692777184e31e936d9f\">chloroquine</span> <span class=\"customMeta\" data-dictid=\"cc20d2d7111692777201fb0caeb3f2\">uptake</span> and efflux, reducing <span class=\"customMeta\" data-dictid=\"65d6c8e3de1692777184e31e936d9f\">chloroquine</span> accumulation within parasites.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Malaria Treatment and Prophylaxis</li>\n<li>Amebiasis</li>\n<li>Leprae reaction</li>\n<li>Giardiasis</li>\n<li>Autoimmune Diseases (RA, SLE)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>S/E</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Ophthalmic: <strong>Bull's eye maculopathy,</strong> <strong>anterior <span class=\"customMeta\" data-dictid=\"550fa75ff216927771992c0987c58e\">subcapsular</span> cataract, <span class=\"customMeta\" data-dictid=\"301da8b9181692777202486306bbd2\">vortex</span> keratopathy, corneal deposits</strong></li>\n<li>Gastrointestinal: Nausea, vomiting, diarrhea</li>\n<li>Skin: Itching, rash, photosensitivity</li>\n<li>Neuropsychiatric: Agitation, confusion, hallucinations</li>\n<li>Cardiac: QT prolongation, <span class=\"customMeta\" data-dictid=\"6e6dd7aed216927771831ebdf9703c\">cardiomyopathy</span> (rare)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Voriconazole is not effective against which of the following?", "options": [{"label": "A", "text": "Candida albicans", "correct": false}, {"label": "B", "text": "Mucormycosis", "correct": true}, {"label": "C", "text": "Candida tropicalis", "correct": false}, {"label": "D", "text": "Aspergillosis", "correct": false}], "correct_answer": "B. Mucormycosis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:613px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Voriconazole </strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is a <span class=\"customMeta\" data-dictid=\"032853dede169277720093484e7e18\">triazole</span> <span class=\"customMeta\" data-dictid=\"c929a2b71516927771812a8b7b7ec3\">antifungal</span> known for its broad spectrum against <span class=\"customMeta\" data-dictid=\"3655d8847516927772026e1e299f2a\">yeast</span> and moulds.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>MOA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inhibits fungal <span class=\"customMeta\" data-dictid=\"08a8798eef1692777199f2a6ba28f4\">sterol</span> 14α-demethylase, disrupting <span class=\"customMeta\" data-dictid=\"b797df98be1692777187039e0c9684\">ergosterol</span> <span class=\"customMeta\" data-dictid=\"3fda45538a1692777199ec2a5478a5\">synthesis</span> in fungal cell membranes.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Spectrum </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Broad spectrum against various fungi</p>\n<ul>\n<li>Candida albicans<strong> (Option A) </strong></li>\n<li>Candida tropicalis <strong>(Option B)</strong></li>\n<li>Aspergillosis <strong>(Option D) </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Adverse Effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common: Nausea, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain, diarrhoea, headache, dizziness.</p>\n<p>Rare: Anaemia, neutropenia, <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrhythmias, visual disturbances.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with gout develops hypertension. The uric acid level was found to be elevated. Which of the following antihypertensives should not be used?", "options": [{"label": "A", "text": "Hydrochlorothiazide", "correct": true}, {"label": "B", "text": "Atenolol", "correct": false}, {"label": "C", "text": "Enalapril", "correct": false}, {"label": "D", "text": "Prazosin", "correct": false}], "correct_answer": "A. Hydrochlorothiazide", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented with biliary colic to the ER. The intern administered an analgesic, which worsened the pain. Which of the following drugs could be responsible for aggravation of the patient’s symptoms?", "options": [{"label": "A", "text": "Morphine", "correct": true}, {"label": "B", "text": "Diclofenac", "correct": false}, {"label": "C", "text": "Nefopam", "correct": false}, {"label": "D", "text": "Etoricoxib", "correct": false}], "correct_answer": "A. Morphine", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following drugs is used for the treatment of motion sickness?", "options": [{"label": "A", "text": "Cetirizine", "correct": false}, {"label": "B", "text": "Promethazine", "correct": true}, {"label": "C", "text": "Misolastin", "correct": false}, {"label": "D", "text": "Loratidine", "correct": false}], "correct_answer": "B. Promethazine", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/BIlBIr93cEIpaSIJSYyT1746435875.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Drug </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>MOA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Side effects</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Promethazine </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Antihistamine with <span class=\"customMeta\" data-dictid=\"b676cf039416927771814f87114511\">antiemetic</span> action</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Drowsiness, dry mouth, blurred vision</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dimenhydrinate </strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>An <span class=\"customMeta\" data-dictid=\"b934c33cc21692777181f55e558ff3\">antihistamine</span> with <span class=\"customMeta\" data-dictid=\"9b4dbbb3321692777181e6fe172b88\">anticholinergic</span> properties</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Drowsiness, dry mouth, blurred vision, constipation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Meclizine </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Scopolamine </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anticholinergic with <span class=\"customMeta\" data-dictid=\"b676cf039416927771814f87114511\">antiemetic</span> action</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Drowsiness, dry mouth, blurred vision</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Drugs for motion sickness</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Anticholinergics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Scopolamine</strong></p>\n<ul>\n<li>\n<ul>\n<li>Used as a <span class=\"customMeta\" data-dictid=\"48982b740216927772004a198271cd\">transdermal</span> patch,</li>\n<li>Use 4 to 5 hours before travel.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Antihistamines</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diphenhydramine</strong>, <strong>Promethazine</strong>, and <strong>Meclizine</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the mechanism of resistance by lactamases to Beta-lactam antibiotics?", "options": [{"label": "A", "text": "Alteration of penicillin-binding proteins proteins", "correct": false}, {"label": "B", "text": "Degradation of antibiotics", "correct": true}, {"label": "C", "text": "Drug efflux", "correct": false}, {"label": "D", "text": "Alteration in 50s ribosome structure", "correct": false}], "correct_answer": "B. Degradation of antibiotics", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>ß-lactam antibiotics</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>MOA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>ß-lactam antibiotics <span class=\"customMeta\" data-dictid=\"6b3de87b7c16927771901326efbcd2\">inhibit</span> the last step in <span class=\"customMeta\" data-dictid=\"8d8d5e23f3169277719592e0c8d2b4\">peptidoglycan</span> <span class=\"customMeta\" data-dictid=\"3fda45538a1692777199ec2a5478a5\">synthesis</span> by acylating the transpeptidase via <span class=\"customMeta\" data-dictid=\"db5610b3121692777184e0965a9fa4\">cleavage</span> of the -CO-N-bond of the ß-lactam ring, thus inhibiting <span class=\"customMeta\" data-dictid=\"97294d26a21692777184b7ddc59c4e\">cell wall</span> synthesis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Drug groups </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1. Penicillin</p>\n<p>2. Cephalosporin</p>\n<p>3. Carbapenems</p>\n<p>4. <span class=\"customMeta\" data-dictid=\"ada14a9fa616927771929ac9bafce2\">Monobactam</span> (Aztreonam)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Resistance </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It occurs through one of the four mechanisms:</p>\n<ol>\n<li><strong>Modification</strong> of target <strong>PBPs</strong> <strong>(Option A)</strong></li>\n<li><strong>Impaired</strong> <strong>penetration</strong> of drugs to target PBPs</li>\n<li>Antibiotic <strong>efflux</strong> <strong>(Option C)</strong></li>\n<li>Inactivation of <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> by <strong>lactamases</strong> <strong>(Option B)</strong></li>\n</ol>\n<p>ß-lactamases are enzymes produced by certain bacteria that <span class=\"customMeta\" data-dictid=\"8bc8a6d0441692777190e9bed75e91\">inactivate</span> ß-lactam antibiotics by <span class=\"customMeta\" data-dictid=\"41255286461692777189199a8b2dc7\">hydrolysis</span> of the ß-lactam ring in their structure.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Pegloticase is used in the management of?", "options": [{"label": "A", "text": "Chronic gout", "correct": true}, {"label": "B", "text": "Rheumatoid arthritis", "correct": false}, {"label": "C", "text": "Psoriatic arthritis", "correct": false}, {"label": "D", "text": "Calcium Pyrophosphate dehydrate deposition", "correct": false}], "correct_answer": "A. Chronic gout", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:626px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Drugs for <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> attack of gout</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>DOC- NSAIDS </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Except for <span class=\"customMeta\" data-dictid=\"deba671f4716927771828c95a320e5\">aspirin</span> and paracetamol</li>\n<li>Anti-inflammatory</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Colchicine </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>MOA: <span class=\"customMeta\" data-dictid=\"ef00bb99bd1692777192dbc816b3d4\">microtubule</span> inhibitor</strong></li>\n<li>Used in <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> attacks of <span class=\"customMeta\" data-dictid=\"0b216ac0561692777188160d9a8814\">gout</span> and <span class=\"customMeta\" data-dictid=\"5dda3cc2ab1692777202b3b3c65bea\">familial</span> Mediterranean fever and is also the <span class=\"customMeta\" data-dictid=\"357ecf18f2169277718661a76111ea\">DOC</span> for karyotyping</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Corticosteroids</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Intra <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">articular</span> injections, avoid oral route</li>\n<li>Immunosuppressive and anti-inflammatory</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Drugs for chronic gout</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Xanthine <span class=\"customMeta\" data-dictid=\"4a14dfa14e1692777194882f818d87\">oxidase</span> inhibitors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Drugs include <span class=\"customMeta\" data-dictid=\"6337926de316927771812a6842721f\">Allopurinol</span> (DOC), Oxipurinol, <strong>Febuxostat</strong></li>\n<li><strong>MOA: Blocks <span class=\"customMeta\" data-dictid=\"c9a23eabc41692777202d1d98467d5\">xanthine</span> <span class=\"customMeta\" data-dictid=\"4a14dfa14e1692777194882f818d87\">oxidase</span> <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> → Inhibits the conversion of <span class=\"customMeta\" data-dictid=\"304c30e55316927771895062b17e8b\">hypoxanthine</span> to <span class=\"customMeta\" data-dictid=\"ffa20262931692777201caef35de16\">uric</span> acid in the liver</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Uric acid <span class=\"customMeta\" data-dictid=\"4a14dfa14e1692777194882f818d87\">oxidase</span> enzyme</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Drugs include <strong>Pegloticase </strong>and Rasburicase</li>\n<li><strong>MOA: <span class=\"customMeta\" data-dictid=\"ffa20262931692777201caef35de16\">Uric</span> acid is converted to <span class=\"customMeta\" data-dictid=\"eae976dfa31692777181804c2b20e7\">allantoin</span> and excreted in urine</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Uricosuric agents</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Drugs include Probenecid, Benzbromaron, Sulfinpyrazone, <strong>Lesinurad</strong></li>\n<li><strong>MOA:</strong> <strong>Inhibit OATP transporter/URAT-1 in the <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> → inhibits <span class=\"customMeta\" data-dictid=\"3086fd09371692777197a351ddde07\">reabsorption</span> of <span class=\"customMeta\" data-dictid=\"ffa20262931692777201caef35de16\">uric</span> acid → increased <span class=\"customMeta\" data-dictid=\"0f7653c9ef1692777187deaa35f749\">excretion</span> of <span class=\"customMeta\" data-dictid=\"ffa20262931692777201caef35de16\">uric</span> acid.</strong></li>\n</ul>\n<p> </p>\n<p>(OATP - Organic <span class=\"customMeta\" data-dictid=\"53e82fca731692777181e629a02799\">anion</span> transport protein, URAT-1 - <span class=\"customMeta\" data-dictid=\"ffa20262931692777201caef35de16\">Uric</span> acid transporter)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is an inhibitor of RNA synthesis?", "options": [{"label": "A", "text": "5-Fluorouracil", "correct": false}, {"label": "B", "text": "Rifampicin", "correct": true}, {"label": "C", "text": "Nitrofurantoin", "correct": false}, {"label": "D", "text": "Novobiocin", "correct": false}], "correct_answer": "B. Rifampicin", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/DDsE1VDgjVhuixn5Z4UA1746436006.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Name of drug</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Rifampin</strong><br/>\n\t\t\t </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism of action</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Interrupts <span class=\"customMeta\" data-dictid=\"cc65bdc03f169277719726a675e8a7\">RNA</span> <span class=\"customMeta\" data-dictid=\"3fda45538a1692777199ec2a5478a5\">synthesis</span> by binding to mycobacterial DNA-dependent <span class=\"customMeta\" data-dictid=\"cc65bdc03f169277719726a675e8a7\">RNA</span> polymerase.</p>\n<p style=\"text-align:center\"><img alt=\"PH164\" data-author=\"\" data-hash=\"11838\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/DDsE1VDgjVhuixn5Z4UA1746436006.png\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Route</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Oral</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cellularity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intracellular and extracellular</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Action</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bactericidal</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>RNA <span class=\"customMeta\" data-dictid=\"3fda45538a1692777199ec2a5478a5\">synthesis</span> inhibitors </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Drugs </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>MOA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Uses </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Rifampicin </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inhibition of bacterial <span class=\"customMeta\" data-dictid=\"cc65bdc03f169277719726a675e8a7\">RNA</span> polymerase</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Antibiotic against <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">Tuberculosis</span> and Leprosy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Actinomycin </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inhibition of DNA and <span class=\"customMeta\" data-dictid=\"cc65bdc03f169277719726a675e8a7\">RNA</span> polymerase</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anticancer agent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Alpha <span class=\"customMeta\" data-dictid=\"b1f2ca95881692777181bb7e22d9d9\">Amanitin</span> </strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p>Inhibition of eukaryotic <span class=\"customMeta\" data-dictid=\"cc65bdc03f169277719726a675e8a7\">RNA</span> <span class=\"customMeta\" data-dictid=\"d419920a6616927771969805c3d65d\">polymerase</span> II</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Found in mushrooms, no <span class=\"customMeta\" data-dictid=\"8dfaeedbf91692777200561b2b1d2f\">therapeutic</span> use</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Triptolide </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Traditional Chinese medicine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Amatoxin </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Found in mushrooms, no <span class=\"customMeta\" data-dictid=\"8dfaeedbf91692777200561b2b1d2f\">therapeutic</span> use</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is an inhibitor of DNA synthesis?", "options": [{"label": "A", "text": "6-Mercaptopurine", "correct": true}, {"label": "B", "text": "Mitomycin", "correct": false}, {"label": "C", "text": "Actinomycin", "correct": false}, {"label": "D", "text": "Asparaginase", "correct": false}], "correct_answer": "A. 6-Mercaptopurine", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/Qlh2oF6sqWnPpXhYPlB71746436156.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Theophylline causes diuresis due to which of the following mechanisms?", "options": [{"label": "A", "text": "Adenosine agonism", "correct": true}, {"label": "B", "text": "PDE 4 inhibition", "correct": false}, {"label": "C", "text": "Beta-2-agonism", "correct": false}, {"label": "D", "text": "PDE 3 inhibition", "correct": false}], "correct_answer": "A. Adenosine agonism", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/EKWzz1rxxXDwcfGKYp8a1746436283.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female patient has been on first-line pharmacological therapy for bipolar disorder for the past 6 months. She has been fasting for the past few days due to religious reasons, and she was presented with seizures, coarse tremors, confusion and weakness of limbs. Which of the following investigations should be done to aid in her diagnosis?", "options": [{"label": "A", "text": "Serum potassium levels", "correct": false}, {"label": "B", "text": "Serum lithium levels", "correct": true}, {"label": "C", "text": "ECG", "correct": false}, {"label": "D", "text": "MRI", "correct": false}], "correct_answer": "B. Serum lithium levels", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Grade </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Serum <span class=\"customMeta\" data-dictid=\"42659effea16927771919c6224e529\">lithium</span> (mEq/L)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Symptoms </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mild </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1.5 - 2.5</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Nausea, vomiting, tremor, fatigue</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Moderate </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2.5 - 3.5</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Confusion, agitation, delirium, tachycardia, hypertonia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Severe </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt; 3.5</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Seizures, hyperthermia, hypotension, Coma</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is used in first-line management of post-menopausal osteoporosis?", "options": [{"label": "A", "text": "Estrogen", "correct": false}, {"label": "B", "text": "Bisphosphonate", "correct": true}, {"label": "C", "text": "Raloxifene", "correct": false}, {"label": "D", "text": "Combined oral contraception", "correct": false}], "correct_answer": "B. Bisphosphonate", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/eOQohY71h0ZAUBlVAx0E1746436515.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:165px\">\n<tbody>\n<tr>\n<td colspan=\"9\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bisphosphonates</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1st generation</strong></p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2nd generation</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3rd generation</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Etidronate</li>\n<li>Clodronate</li>\n</ul>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Alendronate</li>\n<li>Risedronate</li>\n<li>Ibandronate</li>\n</ul>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Zoledronate</li>\n<li>Pamidronate</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of Action</strong></p>\n</td>\n<td colspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Direct <span class=\"customMeta\" data-dictid=\"f03ca2d2a716927771901227bc175a\">inhibition</span> of <span class=\"customMeta\" data-dictid=\"c21bdae5e116927771947204c2076c\">osteoclast</span> activity and bone resorption.</p>\n<p><img alt=\"PH184\" data-author=\"\" data-hash=\"11850\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/eOQohY71h0ZAUBlVAx0E1746436515.png\"/></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Frequency of Administration</strong></p>\n</td>\n<td colspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More potent drugs require less frequent administration</p>\n<ul>\n<li>Alendronate: Given once a week.</li>\n<li>Risedronate: Given once a week.</li>\n<li>Ibandronate: Given once a month.</li>\n<li>Zoledronate: Given once a year.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Uses of Bisphosphonates</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Role of Bisphosphonates</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Osteoporosis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Effective in preventing and treating <span class=\"customMeta\" data-dictid=\"c9ba8fa63616927771962d84263e40\">postmenopausal</span> osteoporosis, age-related, idiopathic, and steroid-induced osteoporosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Paget's Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Arrest osteolytic lesions, reduce bone pain, and improve secondary symptoms.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hypercalcemia of Malignancy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lower <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> levels, especially in severe cases.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Metastatic Bone Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Arrest osteolytic lesions and reduce bone pain.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Adverse effects of Bisphosphonates</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Bisphosphonates</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Adverse effects</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Etidronate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Interference with bone mineralisation, potential osteomalacia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pamidronate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Thrombophlebitis, bone pain, fever, leukopenia, flu-like symptoms.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Alendronate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Esophagitis, <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> erosion, <span class=\"customMeta\" data-dictid=\"db0b2c70cb1692777197d6e5e33d95\">retrosternal</span> pain, flatulence.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ibandronate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Risk of flu-like symptoms with <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> infusion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risedronate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Generally well-tolerated, potential for <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> upset.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Zoledronate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Severe hypocalcemia, nephrotoxicity, flu-like symptoms, <span class=\"customMeta\" data-dictid=\"ffadabff021692777194c8ebe87262\">osteonecrosis</span> of the jaw.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Oral Bisphosphonates causes esophagitis: Should be administered on an empty stomach with plenty of distilled water. Patient should not eat anything and should not lie down for 30 minutes - To avoid <span class=\"customMeta\" data-dictid=\"def94cc96d16927771970d1a5cfb71\">reflux</span> esophagitis.</li>\n<li>Bisphosphonates are associated with an increased risk of <span class=\"customMeta\" data-dictid=\"6aad7ac3ba16927771992f27501295\">Subtrochanteric</span> <span class=\"customMeta\" data-dictid=\"512283ec9816927772024c89478b7d\">femur</span> fracture.</li>\n<li>Bisphosphonates are C/I in <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure.</li>\n<li>Regular <span class=\"customMeta\" data-dictid=\"02cf7655661692777185e2bf5c3254\">dental</span> check-ups are advised to monitor for <span class=\"customMeta\" data-dictid=\"ffadabff021692777194c8ebe87262\">osteonecrosis</span> of the jaw.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with diabetes developed postoperative urinary retention. Which of the following drugs can be used for short-term treatment of the condition?", "options": [{"label": "A", "text": "Tamsulosin", "correct": false}, {"label": "B", "text": "Bethanechol", "correct": true}, {"label": "C", "text": "Terazosin", "correct": false}, {"label": "D", "text": "Methacholine", "correct": false}], "correct_answer": "B. Bethanechol", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Bethanechol</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bethanechol is a <span class=\"customMeta\" data-dictid=\"8656dac49a16927771846b41f8cf19\">cholinergic</span> <span class=\"customMeta\" data-dictid=\"7d8d28cda71692777180c89a3c86ce\">agonist</span> that stimulates <span class=\"customMeta\" data-dictid=\"0ad3c97c2916927771938768dcf298\">muscarinic</span> receptors, which are found primarily in the <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> and <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> tracts.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>MOA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Mimics the effects of acetylcholine, which plays a crucial role in the <span class=\"customMeta\" data-dictid=\"8f19a37b5916927771941ba9f5ef49\">parasympathetic</span> nervous system, at <span class=\"customMeta\" data-dictid=\"0ad3c97c2916927771938768dcf298\">muscarinic</span> receptors.</li>\n<li>Upon stimulating <span class=\"customMeta\" data-dictid=\"0ad3c97c2916927771938768dcf298\">muscarinic</span> receptors, it promotes <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> muscle contraction, aiding in <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> expulsion and reducing <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> retention.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Usage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Postoperative and <span class=\"customMeta\" data-dictid=\"3d885759d516927771966b84bfa470\">Postpartum</span> <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"b668aed705169277719744b6db8f8e\">retention</span> with no actual obstruction.</li>\n<li>Neurogenic bladder.</li>\n<li>Symptomatic relief in <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> megacolon.</li>\n<li>Gastroesophageal reflux</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Side Effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Gastrointestinal: Belching, <span class=\"customMeta\" data-dictid=\"42b110efe11692777190ea5720c867\">involuntary</span> defecation.</li>\n<li>Urinary: <span class=\"customMeta\" data-dictid=\"42b110efe11692777190ea5720c867\">Involuntary</span> urination.</li>\n<li>Other: Flushing, sweating, hypotension.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Contraindications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Mechanical <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> of the <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> or <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> tract.</li>\n<li>Asthma.</li>\n<li>Hypotension.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following drugs acts by inhibiting the late sodium current in the heart?", "options": [{"label": "A", "text": "Ivabradine", "correct": false}, {"label": "B", "text": "Ranolazine", "correct": true}, {"label": "C", "text": "Trimetazidine", "correct": false}, {"label": "D", "text": "Fasudil", "correct": false}], "correct_answer": "B. Ranolazine", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Ranolazine</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>MOA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Inhibits the late sodium current in cardiomyocytes, which helps to reduce <span class=\"customMeta\" data-dictid=\"a621be29da16927771901bc91014d1\">intracellular</span> sodium accumulation during ischemic conditions</li>\n<li>Indirectly reduces <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> <span class=\"customMeta\" data-dictid=\"9d02a99d051692777194aa3375023b\">overload</span> in <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> cells and improves myocardial relaxation, leading to an <span class=\"customMeta\" data-dictid=\"79b064c9dd1692777181324cc128fe\">anti-ischemic</span> effect.</li>\n<li>It decreases <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> diastolic tension, reduces myocardial oxygen consumption, and improves myocardial perfusion</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Uses </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Used as add-on therapy as an <span class=\"customMeta\" data-dictid=\"27f1650ee916927771810ee0b435a7\">Antianginal</span> agent for <strong>Chronic stable angina.</strong></li>\n<li>Reduces the frequency of <span class=\"customMeta\" data-dictid=\"030cd51b341692777181d15302c8d4\">angina</span> pectoris and improves exercise tolerance.</li>\n<li>Ventricular tachycardia.</li>\n<li>Improves <span class=\"customMeta\" data-dictid=\"b5f500def916927771888b49285ac6\">glycemic</span> control (lower HbA1c and increase insulin)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Adverse effect </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Dizziness, headache, <span class=\"customMeta\" data-dictid=\"9a8412e39e1692777193c550a5dbb4\">nausea</span> and asthenia</li>\n<li>Constipation and Liver failure</li>\n<li>QT-prolongation and rarely <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">Ventricular</span> <span class=\"customMeta\" data-dictid=\"5280ec6ae91692777182aa6322ae68\">arrhythmia</span> such as Torsades <span class=\"customMeta\" data-dictid=\"233d458dd316927771854358419c86\">de</span> pointes.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following hormones use receptor tyrosine kinase signalling?", "options": [{"label": "A", "text": "Insulin", "correct": true}, {"label": "B", "text": "TSH", "correct": false}, {"label": "C", "text": "TRH", "correct": false}, {"label": "D", "text": "MSH", "correct": false}], "correct_answer": "A. Insulin", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which type of nerve fiber is most likely to be affected in a 35-year-old female who experienced a tingling sensation over her arm after watching TV for an extended period of time with her hands placed under her head?", "options": [{"label": "A", "text": "A", "correct": true}, {"label": "B", "text": "B", "correct": false}, {"label": "C", "text": "C", "correct": false}, {"label": "D", "text": "Sympathetic", "correct": false}], "correct_answer": "A. A", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:780px\">\n<tbody>\n<tr>\n<td colspan=\"8\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Classification of nerve fibres - Erlanger and Gasser and Lloyd-Hunt </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Fiber Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Erlanger-Gasser Classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Lloyd-Hunt Classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Myelination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Function</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Conduction <span class=\"customMeta\" data-dictid=\"12c4510e191692777201c23ec126a3\">Velocity</span> (m/s)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Diameter (µm)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Sensitivity to Blockade</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Aα</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Aα</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Ia, Ib</p>\n</td>\n<td rowspan=\"5\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Myelinated</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Proprioception, <span class=\"customMeta\" data-dictid=\"3db910d8571692777198303e3bcb27\">somatic</span> motor</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>70-120</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>12-20</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Pressure - Most <span class=\"customMeta\" data-dictid=\"55691242bb1692777199360f64cb67\">susceptible</span> <strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Aβ</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Aβ</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>II</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Touch, pressure</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>30-70</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>5-12</p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Pressure - Intermediate.</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Aγ</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Aγ</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Motor to muscle spindles</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>15-30</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>3-6</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Aδ</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Aδ</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>III</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Pain (fast), temperature (cold)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>12-30</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>2-5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>B</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>B</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Preganglionic autonomic</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>3-15</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>&lt;3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Hypoxia - Most <span class=\"customMeta\" data-dictid=\"55691242bb1692777199360f64cb67\">susceptible</span> <strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>C<br/>\n\t\t\t(Dorsal Root)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>C</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>IV</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Unmyelinated</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Pain (slow), temperature (warm)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>0.5-2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>0.4-1.2</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Local anesthetics - Most <span class=\"customMeta\" data-dictid=\"55691242bb1692777199360f64cb67\">susceptible</span> <strong>(Options C &amp; D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>C (Sympathetic)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>C</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Postganglionic sympathetic</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>0.7-2.3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>0.3-1.3</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What makes CPDA superior to ACD for blood storage, except:", "options": [{"label": "A", "text": "The fall in 2,3 DPG is less", "correct": false}, {"label": "B", "text": "B) Improved Viability of Red Blood Cells", "correct": false}, {"label": "C", "text": "Increased Potassium Load", "correct": true}, {"label": "D", "text": "It is less acidic", "correct": false}], "correct_answer": "C. Increased Potassium Load", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Sharp waste is disposed of in?", "options": [{"label": "A", "text": "Yellow bag", "correct": false}, {"label": "B", "text": "Red bag", "correct": false}, {"label": "C", "text": "Blue bag", "correct": false}, {"label": "D", "text": "White bag", "correct": true}], "correct_answer": "D. White bag", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:685px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Colour</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type of waste</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Example of waste</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Treatment and disposal</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Yellow (Option A ruled out)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Human <span class=\"customMeta\" data-dictid=\"116f86834a1692777181a914379270\">anatomical</span> waste.</li>\n<li>Animal <span class=\"customMeta\" data-dictid=\"116f86834a1692777181a914379270\">anatomical</span> waste.</li>\n<li>Soiled waste.</li>\n<li>Discarded or expired medicine.</li>\n<li>Microbiology, <span class=\"customMeta\" data-dictid=\"177a32fb7f1692777183fcc83ba413\">biotechnology</span> and other <span class=\"customMeta\" data-dictid=\"3ec60edb4a16927771842bb9fd9aa4\">clinical laboratory</span> waste.</li>\n<li>Chemical waste.</li>\n<li>Chemical liquid waste.</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Placenta.</li>\n<li>Post-operative body parts.</li>\n<li>Plaster of Paris (POP).</li>\n<li>Pathological waste.</li>\n<li>Cotton waste.</li>\n<li>Dressing materials.</li>\n<li>Beddings.</li>\n<li>Body fluid contaminated paper and cloth.</li>\n<li>Face mask, cap, shoe cover and head cover.</li>\n<li>Cytotoxic, expired and discarded medicines.</li>\n<li>Microbiology and <span class=\"customMeta\" data-dictid=\"177a32fb7f1692777183fcc83ba413\">biotechnology</span> lab waste.</li>\n<li>Blood bag</li>\n<li>Vacutainers with blood</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Incineration.</li>\n<li>Plasma pyrolysis.</li>\n<li>Deep burial.</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Red (Option B ruled out)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Contaminated waste that is recyclable.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Syringe without needles.</li>\n<li>Fixed needle syringes with their needle cut.</li>\n<li>IVset.</li>\n<li>Catheters.</li>\n<li>Gloves (soiled or unsoiled).</li>\n<li>Urine bag.</li>\n<li>Dialysis kit.</li>\n<li>IVbottles.</li>\n<li>Tubing's.</li>\n<li>Bottles.</li>\n<li>Vacutainers with needle cut.</li>\n<li>Vacutainers without blood.</li>\n<li>ELISA plate and vials not containing blood samples.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Autoclaving or microwaving/ hydroclaving followed by shredding or <span class=\"customMeta\" data-dictid=\"07bda0bb4f1692777193a54fe56f9c\">mutilation</span> and waste set to registered recyclers or for energy recovery/road making.</li>\n<li>Plastic waste should not be sent to landfill sites.</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>White (Option D)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Waste Sharps</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Needles</li>\n<li>Syringes with fixed needles</li>\n<li>Blades</li>\n<li>Scalpers</li>\n<li>Trocar cannula</li>\n<li>Insulin pen needle</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Puncture proof , Leak proof, Tamper proof containers</li>\n<li>Autoclaving or <span class=\"customMeta\" data-dictid=\"2d95ddf7b8169277718654aee27077\">dry heat</span> <span class=\"customMeta\" data-dictid=\"f39be0f0871692777199459d86e0a7\">sterilization</span> followed by shredding or <span class=\"customMeta\" data-dictid=\"07bda0bb4f1692777193a54fe56f9c\">mutilation</span> or <span class=\"customMeta\" data-dictid=\"5a7f7caa7716927771870658b1c5cf\">encapsulation</span> in metal container or <span class=\"customMeta\" data-dictid=\"d8691a48a91692777184708a8f2f0c\">cement</span> concrete</li>\n<li>Or sent for final disposal to iron foundries or <span class=\"customMeta\" data-dictid=\"601fb1538a16927771987048f6e712\">sanitary</span> landfill or designated concrete waste sharp pit</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Blue</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Glassware or <span class=\"customMeta\" data-dictid=\"84433cae211692777192a484f539bc\">metallic</span> body implants.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Includes broken or discarded glass and <span class=\"customMeta\" data-dictid=\"84433cae211692777192a484f539bc\">metallic</span> objects that are contaminated.</li>\n<li>Glass:\n\t\t\t\t<ul>\n<li>Broken glass.</li>\n<li>Ampoules.</li>\n<li>Lab slide</li>\n</ul>\n</li>\n<li>Metals:\n\t\t\t\t<ul>\n<li>Nails.</li>\n<li>Metallic body implants.</li>\n<li>Scissors.</li>\n<li>Artificial pacemakers.</li>\n</ul>\n</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Cardboard boxes with blue coloured marking or blue coloured puncture- proof and tamper-proof containers.</li>\n<li>Disinfection (cleaning with <span class=\"customMeta\" data-dictid=\"24ff542ee616927771865a28edbc12\">detergent</span> and soaking in sodium hypochlorite) or autoclaving or microwaving or hydroclaving and then sent for recycling.</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Among the given options, which condition is expected to exhibit the greatest levels of ACTH and cortisol?", "options": [{"label": "A", "text": "Early morning", "correct": false}, {"label": "B", "text": "Normal individuals with dexamethasone administration", "correct": false}, {"label": "C", "text": "Addison's disease", "correct": false}, {"label": "D", "text": "Cushing's disease", "correct": true}], "correct_answer": "D. Cushing's disease", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/AzLSW6Oo1D4uMXGsX1LG1746434654.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "As per the Factories Act 1948, what is the maximum number of work hours allowed per week, including any hours worked as overtime?", "options": [{"label": "A", "text": "48 hours", "correct": false}, {"label": "B", "text": "72 hours", "correct": false}, {"label": "C", "text": "60 hours", "correct": true}, {"label": "D", "text": "66 hours", "correct": false}], "correct_answer": "C. 60 hours", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Prolactin level is highest during?", "options": [{"label": "A", "text": "24 hours after ovulation", "correct": false}, {"label": "B", "text": "24 hours after delivery", "correct": true}, {"label": "C", "text": "REM sleep", "correct": false}, {"label": "D", "text": "After running four 1 hours", "correct": false}], "correct_answer": "B. 24 hours after delivery", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/aOBbup9g7FIPYsk8vF9U1746434810.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is an example of prospective screening?", "options": [{"label": "A", "text": "Cervical Pap smear in a 40-year-old patient", "correct": false}, {"label": "B", "text": "Neonatal screening of a new-born baby for hypothyroidism", "correct": false}, {"label": "C", "text": "Screening of immigrants for infectious diseases such as tuberculosis", "correct": true}, {"label": "D", "text": "Urine for sugar screening in a 40-year-old man", "correct": false}], "correct_answer": "C. Screening of immigrants for infectious diseases such as tuberculosis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Prescriptive Screening</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Prospective Screening </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Done for their own benefit.</li>\n<li>Secondary level of prevention.</li>\n<li>Early diagnosis.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Done for other's benefit.</li>\n<li>The primary level of prevention.</li>\n<li>Control/ prevention of disease.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>E.g.</p>\n<ul>\n<li>Screening neonates for <span class=\"customMeta\" data-dictid=\"77493a5b781692777193df12530299\">neonatal</span> <span class=\"customMeta\" data-dictid=\"8d4d1904791692777189941782330d\">hypothyroidism</span> <strong>(Option B ruled out)</strong></li>\n<li>Deafness in children</li>\n<li>Blood <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> testing for <span class=\"customMeta\" data-dictid=\"b6a934c67b16927771868fca92baf9\">diabetes mellitus</span> and gestational diabetes</li>\n<li>Mammography for breast cancer</li>\n<li>Pap <span class=\"customMeta\" data-dictid=\"6777533153169277719804fcbbf2d1\">smear</span> for <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> cancer <strong>(Option A ruled out)</strong></li>\n<li>Visual <span class=\"customMeta\" data-dictid=\"80d33aa6081692777180a22947db2c\">acuity</span> for <span class=\"customMeta\" data-dictid=\"cae831e44316927771973fa5e13fd7\">refractive</span> errors.</li>\n<li>Urine sugar screening for diabetes <strong>(Option D ruled out)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>E.g.</p>\n<ul>\n<li>Screening of immigrants for diseases like TB and COVID <strong>(Option C)</strong></li>\n<li>HIV screening for blood donation</li>\n<li>HIV screening in ANC cases</li>\n<li>Health checkups for workers in the food industry.</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Following complete ileal and partial jejunal resection, the patient is most likely to develop?", "options": [{"label": "A", "text": "Folic acid deficiency", "correct": false}, {"label": "B", "text": "Vitamin B12 deficiency", "correct": true}, {"label": "C", "text": "Iron deficiency", "correct": false}, {"label": "D", "text": "Reduced absorption of carbohydrates", "correct": false}], "correct_answer": "B. Vitamin B12 deficiency", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:736px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Vitamin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Primary <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">Absorption</span> Site</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mechanism of <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">Absorption</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fat-Soluble</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A</p>\n<p>D</p>\n<p>E</p>\n<p>K</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Small <span class=\"customMeta\" data-dictid=\"7840cca3ed16927771901d2f6cb32b\">intestine</span> (Duodenum, mainly jejunum).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Require <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> salts for emulsification.</li>\n<li>Incorporated into mixed micelles.</li>\n<li>Absorbed by <span class=\"customMeta\" data-dictid=\"c72d29ec4116927771942153c0d252\">passive</span> <span class=\"customMeta\" data-dictid=\"9c760dcb641692777186f4cda5dc95\">diffusion</span> into enterocytes.</li>\n<li>Packaged into chylomicrons for transport.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Water-Soluble</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>B Vitamins</p>\n<p> </p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Jejunum and Ileum.</p>\n<p>(B12 specifically in ileum)</p>\n<p> </p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Various mechanisms include:</p>\n<ul>\n<li>Active transport</li>\n<li>Passive diffusion</li>\n<li>Carrier-mediated transport</li>\n<li>Sodium-dependent transport</li>\n<li>B12 requires an <span class=\"customMeta\" data-dictid=\"a6795c876e169277719057a1099465\">intrinsic</span> factor</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>C</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Sodium-dependent <span class=\"customMeta\" data-dictid=\"74c9c0942a1692777180b936bbbfcc\">active transport</span> at low concentrations.</li>\n<li>Passive <span class=\"customMeta\" data-dictid=\"9c760dcb641692777186f4cda5dc95\">diffusion</span> at high concentrations.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Respiratory distress syndrome is caused due to defective?", "options": [{"label": "A", "text": "Type 1 pneumocytes", "correct": false}, {"label": "B", "text": "Type 2 pneumocytes", "correct": true}, {"label": "C", "text": "Alveolar capillary endothelial cells", "correct": false}, {"label": "D", "text": "Bronchial mucosal epithelial cells", "correct": false}], "correct_answer": "B. Type 2 pneumocytes", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A person develops headache and breathlessness on a trekking expedition following a rapid ascent to over 3000 meters above the sea level. Which of the following is not used in the treatment of this condition?", "options": [{"label": "A", "text": "IV digoxin", "correct": true}, {"label": "B", "text": "Immediate descent", "correct": false}, {"label": "C", "text": "Administration of oxygen", "correct": false}, {"label": "D", "text": "Tablet acetazolamide", "correct": false}], "correct_answer": "A. IV digoxin", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Acute Mountain Sickness</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Headache</li>\n<li>Nausea</li>\n<li>Fatigue</li>\n<li>Insomnia</li>\n<li>Appear hours to days after rapid ascent</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Associated with cerebral oedema, caused by increased <span class=\"customMeta\" data-dictid=\"89e3252d5b16927771833fb9b432ae\">capillary</span> pressure in the brain due to <span class=\"customMeta\" data-dictid=\"d141b433d2169277718681e3ff6bc3\">dilation</span> of blood vessels in response to low oxygen levels.</li>\n<li>The increased <span class=\"customMeta\" data-dictid=\"1c7103a9b516927771955682b6aaa4\">permeability</span> of the <span class=\"customMeta\" data-dictid=\"d89cb634601692777183adec401a59\">blood-brain barrier</span> contributes to fluid leakage into brain tissue.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Descending to a lower altitude <strong>(Option B ruled out)</strong></li>\n<li>Supplemental oxygen <strong>(Option C ruled out)</strong></li>\n<li>Acetazolamide to facilitate <span class=\"customMeta\" data-dictid=\"4ceeb0cef2169277718080f29afe8d\">acclimatization</span> <strong>(Option D ruled out)</strong></li>\n<li>In severe cases, corticosteroids may be used to reduce cerebral oedema.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In which of the following reflexes, gastric emptying is delayed when acidic content enters the duodenum?", "options": [{"label": "A", "text": "Gastrocolic", "correct": false}, {"label": "B", "text": "Intestino intestinal", "correct": false}, {"label": "C", "text": "Gastroileal", "correct": false}, {"label": "D", "text": "Enterogastric", "correct": true}], "correct_answer": "D. Enterogastric", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Factor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Acid in the duodenum</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Releases secretin, inhibiting antral <span class=\"customMeta\" data-dictid=\"ca2289e348169277718516017eb2ba\">contraction</span> and stimulating <span class=\"customMeta\" data-dictid=\"0319b53dbd16927771968db216b352\">pyloric sphincter</span> contraction</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Products of fat digestion</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Releases <span class=\"customMeta\" data-dictid=\"329e9ba42816927771838b17a56efc\">CCK</span> and GIP, inhibiting <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> emptying</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hypertonic solutions in the duodenum</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Releases hormones inhibiting <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> emptying</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Products of protein digestion</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Releases gastrin, CCK, and GIP, inhibiting <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> emptying</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Large meal volume (solids)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Prolongs <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> <span class=\"customMeta\" data-dictid=\"397f16a7a71692777187ffffefa7e6\">emptying</span> time</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Stretching of duodenum</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Initiates <strong>enterogastric reflex</strong>, inhibiting <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> <span class=\"customMeta\" data-dictid=\"397f16a7a71692777187ffffefa7e6\">emptying</span> <strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sympathetic stimulation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreased <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> <span class=\"customMeta\" data-dictid=\"c8c1db40c9169277719258df1a6b43\">motility</span> (by norepinephrine) and increased <span class=\"customMeta\" data-dictid=\"0319b53dbd16927771968db216b352\">pyloric sphincter</span> tone.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hormones (CCK, GIP, secretin)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the next course of action in managing a 24-month-old child weighing 11 kg who was presented to the pediatric OPD with a respiratory rate of 38/min and chest indrawing observed during examination?", "options": [{"label": "A", "text": "Oral amoxicillin for five days", "correct": true}, {"label": "B", "text": "Urgent referral to the tertiary care centre immediately", "correct": false}, {"label": "C", "text": "Administer IV antibiotics and ask the patient to be brought after 24 hours", "correct": false}, {"label": "D", "text": "Start antipyretics urgently", "correct": false}], "correct_answer": "A. Oral amoxicillin for five days", "question_images": [], "explanation_images": [], "explanation": "<table>\n<thead>\n<tr>\n<th>Clinical Signs</th>\n<th>Classification</th>\n<th>Treatment / Action</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>No fast breathing, no chest indrawing, no danger</td>\n<td>No pneumonia</td>\n<td>Home care, fluids, continued feeding, follow-up</td>\n</tr>\n<tr>\n<td>Fast breathing and/or chest indrawing</td>\n<td>Pneumonia</td>\n<td>Oral amoxicillin, home care, follow-up</td>\n</tr>\n<tr>\n<td>Any general danger sign* or <span class=\"customMeta\" data-dictid=\"c8af142f48169277719965c593fa0b\">stridor</span> in calm child</td>\n<td>Severe pneumonia</td>\n<td>Injectable antibiotics, urgent referral to hospital </td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which functional area is most likely to be impacted by the vascular injury to the inferior frontal gyrus in this female patient?", "options": [{"label": "A", "text": "Motor speech area", "correct": true}, {"label": "B", "text": "Wernicke's area", "correct": false}, {"label": "C", "text": "Auditory area", "correct": false}, {"label": "D", "text": "Visual area", "correct": false}], "correct_answer": "A. Motor speech area", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Py8drqBgAYLPoqCR13901745217390.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:642px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Brodmann’s numbers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Function</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>BA 1, 2, 3</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Primary <span class=\"customMeta\" data-dictid=\"be46da176016927771984a269a5b2c\">Somatosensory</span> Cortex</strong></li>\n<li>Processes <span class=\"customMeta\" data-dictid=\"ff110f2cb71692777200a3483aa670\">tactile</span> information from the body.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Postcentral gyrus.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>BA 4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Primary Motor Cortex</strong></li>\n<li>Controls voluntary movements via <span class=\"customMeta\" data-dictid=\"a218fdbabf1692777185a2d48a9e1c\">corticospinal</span> and cortico-nuclear tracts.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Precentral gyrus.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>BA 8 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Prefrontal Cortex</strong></li>\n<li>Involved in planning and decision-making.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> part of the <span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\">frontal</span> lobe.</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>BA 17 </strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Primary Visual <span class=\"customMeta\" data-dictid=\"cab8787ce916927771852a7e72f34d\">Cortex</span> (V1)</strong></li>\n<li>Processes visual information from the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"00b4dbe9e4169277718881a95f7864\">geniculate</span> nucleus. <strong>(Option D ruled out)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Occipital <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> (calcarine sulcus, cuneus, and <span class=\"customMeta\" data-dictid=\"f7c3ba6f1c1692777191e58e8571b0\">lingual</span> gyrus).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>BA 22</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Language comprehension (<strong>Wernicke’s area</strong>) <strong>(Option B ruled out)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Superior <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> gyrus</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>BA 41</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Primary <span class=\"customMeta\" data-dictid=\"f17057f75016927771829e70074368\">auditory</span> <span class=\"customMeta\" data-dictid=\"cab8787ce916927771852a7e72f34d\">cortex</span> (Option C ruled out)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Superior <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> gyrus</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>BA 42</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Secondary <span class=\"customMeta\" data-dictid=\"f17057f75016927771829e70074368\">auditory</span> cortex</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Adjacent to BA 41</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>BA 44 and 45</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Broca’s area </strong></li>\n<li>Speech production. (Motor speech)<strong> (Option A )</strong></li>\n<li>BA 44 (Opercular part): <span class=\"customMeta\" data-dictid=\"6a39c0ac2416927771992990d1db39\">Syntactic</span> processing (grammar).</li>\n<li>BA 45 (Triangular part): <span class=\"customMeta\" data-dictid=\"8c63481bec169277719894cba92261\">Semantic</span> processing (meaning).</li>\n<li>Left BA 44 is typically larger, reflecting language dominance.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inferior <span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\">frontal</span> <span class=\"customMeta\" data-dictid=\"231fafb8e116927771888a0efe57f1\">gyrus</span> of the <span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\">frontal</span> lobe.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A maid is playing with a child by spinning him while holding his hands. A few hours later, the child starts crying, does not use his arm, and does not let anybody touch him. What is the possible diagnosis?", "options": [{"label": "A", "text": "Pulled elbow", "correct": true}, {"label": "B", "text": "Olecranon fracture", "correct": false}, {"label": "C", "text": "Fracture head of radius", "correct": false}, {"label": "D", "text": "Elbow dislocation", "correct": false}], "correct_answer": "A. Pulled elbow", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ef83LKaYTVKuEtM6w3J41745217463.png", "https://image.prepladder.com/content/ZXfBuFlzuAnA42qypBRA1745217470.png", "https://image.prepladder.com/content/ZQvrPpddmW8MXQ5zhnYX1745217479.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Pulled Elbow (also known as Nursemaid’s Elbow)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age group </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1-5 years (most common)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A sudden <span class=\"customMeta\" data-dictid=\"b88c1802e21692777190700ee5b998\">jerk</span> or pull on the arm when it is <strong>extended and pronated</strong> causes the <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> head to slip out of the <span class=\"customMeta\" data-dictid=\"96f5104d6816927771816ac8dfceeb\">annular</span> <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> (radial head subluxation).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical presentation </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The child holds the affected arm close to the body in a <strong>slightly flexed and pronated</strong> position, resisting movement, particularly supination.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>X-ray </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Diagnosis is usually clinical.</li>\n<li>X-ray is unnecessary unless there is suspicion of other injuries.\n\t\t\t\t<ul>\n<li>It may appear normal</li>\n<li>If visible, they can show subtle <strong>displacement of the <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> head</strong>, with the possible <span class=\"customMeta\" data-dictid=\"a1f256489a16927771870ddd296574\">elevation</span> of the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> fat pad or visibility of the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> fat pad, indicating joint effusion.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reduction of the <span class=\"customMeta\" data-dictid=\"e53b153fb316927771996481a3e88f\">subluxation</span> by <strong>supination and flexion</strong> or <strong>hyperpronation</strong> of the <span class=\"customMeta\" data-dictid=\"258a5bb5841692777203cfb8e31f55\">forearm</span> typically results in immediate relief.</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the duration of the extended sickness benefit provided to an employee who has been diagnosed with TB?", "options": [{"label": "A", "text": "1 year", "correct": false}, {"label": "B", "text": "2 years", "correct": true}, {"label": "C", "text": "3 years", "correct": false}, {"label": "D", "text": "4 years", "correct": false}], "correct_answer": "B. 2 years", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:701px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Benefits of ESI(Employees State Insurance) Act.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Medical Benefit</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Provides \"full medical care,\" including <span class=\"customMeta\" data-dictid=\"277d6f3ee2169277718938e321258f\">hospitalization</span> <span class=\"customMeta\" data-dictid=\"1a8e8831bb1692777182ce2c8a751f\">at no</span> cost to insured individuals &amp; families in cases of sickness, employment injury, and maternity.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sickness Benefit</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Provides 70% of average daily wages in cash during medical leave for a maximum of 91 days within 365 days, as certified by the Insurance Medical Officer/Practitioner.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Extended <span class=\"customMeta\" data-dictid=\"73c1caf8d11692777198b1248373d3\">Sickness</span> Benefit</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Extended coverage for long-term diseases beyond 91 days; 34 diseases covered if employed for <strong>two years.</strong></p>\n<p>Extended <span class=\"customMeta\" data-dictid=\"73c1caf8d11692777198b1248373d3\">sickness</span> benefit is paid at 80% of the insured person's wages.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Enhanced <span class=\"customMeta\" data-dictid=\"73c1caf8d11692777198b1248373d3\">Sickness</span> Benefit</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Cash benefits (100% wages) for sterilisation procedures:\n\t\t\t\t<ul>\n<li>14 days for <span class=\"customMeta\" data-dictid=\"2a6989bad01692777201a73b82b799\">tubectomy</span> (women),</li>\n<li>7 days for <span class=\"customMeta\" data-dictid=\"8b8c53004d1692777201cf3df335f5\">vasectomy</span> (men).</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Maternity Benefit</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Cash payments for childbirth, miscarriage, or pregnancy-related sickness:\n\t\t\t\t<ul>\n<li>26 weeks for childbirth,</li>\n<li>6 weeks for miscarriage, and</li>\n<li>40 days for pregnancy-related sickness.</li>\n</ul>\n</li>\n<li>Paid at 100% of the insured woman's average daily wages.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Disablement Benefit</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Temporary Disablement Benefit (TDB):\n\t\t\t\t<ul>\n<li>90% of wages paid from day one for temporary employment injury, until recovery.</li>\n</ul>\n</li>\n<li>Permanent Disablement Benefit (PDB):\n\t\t\t\t<ul>\n<li>90% of wages paid monthly for life, based on certified loss of earning capacity.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dependent's Benefit</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Dependents receive 90% of the deceased's (due to employment injuries) wages as a shared pension, eligible until age 18 or earlier for married daughters.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Funeral Expenses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Offers a cash payment up to Rs. 15,000 to cover funeral expenses upon the death of an insured individual.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Rehabilitation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Insured individuals and their families are entitled to continued medical treatment even after permanent disablement or retirement.</li>\n<li>They have to pay a <span class=\"customMeta\" data-dictid=\"01cc201eb616927771937a9ae6c669\">nominal</span> fee of Rs.10 per month to avail this benefit.</li>\n<li>Rehabilitation <span class=\"customMeta\" data-dictid=\"f8330e788f16927771812e4f73b80c\">allowance</span> of Rs.15,000 granted.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Unemployment allowance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>For eligible employees due to factory <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> or retrenchment: 50% of wage for up to two years.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with a midline swelling in the neck. A biopsy reveals Orphan Annie's eye nuclei, as shown in the image below. What is the diagnosis?", "options": [{"label": "A", "text": "Follicular carcinoma", "correct": false}, {"label": "B", "text": "Papillary carcinoma", "correct": true}, {"label": "C", "text": "Toxic nodular goitre", "correct": false}, {"label": "D", "text": "Medullary carcinoma", "correct": false}], "correct_answer": "B. Papillary carcinoma", "question_images": ["https://image.prepladder.com/content/2aoiM1aBQAnCzMXndGxL1745217730.png"], "explanation_images": ["https://image.prepladder.com/content/60oDEsfgPmsXpR3BrgNs1745217800.png", "https://image.prepladder.com/content/zpM0RvA4N29RggDMuwcq1745217800.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In order to evaluate the nutritional status of young children residing in rural and urban areas, a research study was conducted. The study revealed that out of the total sample, comprising 30 children from rural areas and 20 children from urban areas, a significant proportion were found to be malnourished. Based on this information, which of the following statistical significance tests would be the most suitable in this scenario?", "options": [{"label": "A", "text": "Chi-Square test", "correct": true}, {"label": "B", "text": "Paired T-test", "correct": false}, {"label": "C", "text": "Standard error of the mean", "correct": false}, {"label": "D", "text": "ANOVA", "correct": false}], "correct_answer": "A. Chi-Square test", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/89ZwVkvFCm5l03qr2z9B1746434399.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:1px solid #131314; vertical-align:top\">\n<p><strong>Parametric Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:1px solid #131314; vertical-align:top\">\n<p>Description</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>Paired Student's T-test <strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>Used to compare means (± SD) in paired data from the same group of individuals before and after an intervention.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>Unpaired Student's T-test</p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>Used to compare means (± SD) in two different groups of individuals. The<strong> Z-test is a <span class=\"customMeta\" data-dictid=\"0efdcdc9e01692777201003c81c85a\">variant</span> </strong>of the unpaired Student's t-test used when the sample size is &gt; 30.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>ANOVA <strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>Used to compare means (± SD) in more than two different groups of individuals.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #131314; border-left:1px solid #131314; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>Pearson correlation coefficient</p>\n</td>\n<td style=\"border-bottom:1px solid #131314; border-left:none; border-right:1px solid #131314; border-top:none; vertical-align:top\">\n<p>Measures the <span class=\"customMeta\" data-dictid=\"d02067c4b51692777191b8eec8b062\">linear</span> association between two variables and can range from -1 (perfect negative correlation) to +1 (perfect positive correlation).</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "According to NCEP-ATP III guidelines, which of the following does not meet the criteria for metabolic syndrome?", "options": [{"label": "A", "text": "Hypertriglyceridemia", "correct": false}, {"label": "B", "text": "High LDL", "correct": true}, {"label": "C", "text": "Central obesity", "correct": false}, {"label": "D", "text": "Hypertension", "correct": false}], "correct_answer": "B. High LDL", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 51-year-old male patient presents with complaints of hematuria. On examination, he is normotensive and has pedal edema. Investigations reveal that the patient has no glycosuria and a creatinine level of 9. His renal biopsy finding is given below. Which of the following investigations should be done to identify the disease?", "options": [{"label": "A", "text": "ANA", "correct": false}, {"label": "B", "text": "Anti-GBM antibodies", "correct": true}, {"label": "C", "text": "HIV RNA", "correct": false}, {"label": "D", "text": "Urine immunoelectrophoresis", "correct": false}], "correct_answer": "B. Anti-GBM antibodies", "question_images": ["https://image.prepladder.com/content/TNh2fLAoC7bW1GlY2pjA1745217920.png"], "explanation_images": ["https://image.prepladder.com/notes/EbWjNuzfVZj1epUUM2Tf1746437456.png", "https://image.prepladder.com/notes/iBxNMbfhIyjufWK8M2BK1746437585.png", "https://image.prepladder.com/notes/l1BZ6VvgSNftfIVZEpg11746437697.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:719px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type I RPGN </strong></p>\n<p><strong>(Anti-GBM Ab-mediated)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type II RPGN </strong></p>\n<p><strong>(Immune complex-mediated)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type III RPGN (Pauci-immune) (M/C type)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Includes:</strong></p>\n<ol>\n<li>Idiopathic</li>\n<li>Goodpasture syndrome</li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Includes:</strong></p>\n<ol>\n<li>Idiopathic</li>\n<li>Postinfectious glomerulonephritis</li>\n<li><strong>Lupus (SLE) <span class=\"customMeta\" data-dictid=\"d4d4bbdd341692777193b705a75667\">nephritis</span> </strong></li>\n<li><strong>Henoch-Schönlein purpura</strong></li>\n<li><strong>IgA nephropathy</strong></li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Includes:</strong></p>\n<ol>\n<li>ANCA-associated</li>\n<li>Idiopathic</li>\n<li>Granulomatosis with <span class=\"customMeta\" data-dictid=\"9a6ce977bc1692777196a292871244\">polyangiitis</span> (formerly <strong>Wegener granulomatosis</strong>)</li>\n<li>Microscopic polyangiitis</li>\n</ol>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>IF finding:</strong></p>\n<p>Linear/ribbon pattern (Linear GBM deposits of IgG and C3)<br/>\n\t\t\t </p>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"PA576\" data-author=\"Dash, Aruna &amp; Fatima, Huma &amp; Grewal, Mandeep &amp; Galphin, Claude &amp; Paueksakon, Paisit\" data-hash=\"11855\" data-license=\"CC BY NC 4.0\" data-source=\"https://www.researchgate.net/figure/Linear-staining-of-the-glomerular-capillary-wall-for-IgG-anti-IgG-immunofluorescence_fig3_274505083\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/EbWjNuzfVZj1epUUM2Tf1746437456.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>IF finding:</strong></p>\n<p>Lumpy Bumpy/ Granular/ Starry Sky/Garland Pattern (granular <span class=\"customMeta\" data-dictid=\"9d7a12cab116927771811a0079086d\">antibody</span> deposits)</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"PA575\" data-author=\"Al Hussain, Turki &amp; Asiri, Shuaa &amp; Mana, Hadeel &amp; Akhtar, Mohammed\" data-hash=\"11856\" data-license=\"CC BY-NC SA 4.0\" data-source=\"https://www.researchgate.net/figure/Immunofluorescent-microscopic-pattern-of-staining-for-IgG-in-a-patient-with-immune_fig3_317080802\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/iBxNMbfhIyjufWK8M2BK1746437585.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>IF finding:</strong></p>\n<p>No deposits</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Electron microscopy: R</strong>PGN causes <strong>R</strong>upture and w<strong>R</strong>inkling of GBM</p>\n<figure class=\"caption_element\"><img alt=\"PA577\" data-author=\"HIR, MICHEL LE*; KELLER, CORNELIA*; ESCHMANN, VALÉRIE*; HÄHNEL, BRUNHILDE†; HOSSER, HILTRAUDE†; KRIZ, WILHELM†\" data-hash=\"11857\" data-license=\"PL\" data-source=\"https://journals.lww.com/jasn/fulltext/2001/10000/podocyte_bridges_between_the_tuft_and_bowman_s.7.aspx\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/l1BZ6VvgSNftfIVZEpg11746437697.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The patient presents with a clean-cut injury that is not torn. He mentions receiving a tetanus vaccination approximately 10 years ago. What is the appropriate course of action?", "options": [{"label": "A", "text": "Full course of tetanus vaccination", "correct": false}, {"label": "B", "text": "Single dose tetanus toxoid", "correct": true}, {"label": "C", "text": "Tetanus toxoid + immunoglobulin", "correct": false}, {"label": "D", "text": "Non vaccination needed", "correct": false}], "correct_answer": "B. Single dose tetanus toxoid", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Large, friable, irregular vegetation on heart valves is seen in which condition?", "options": [{"label": "A", "text": "Infective endocarditis", "correct": true}, {"label": "B", "text": "Rheumatic heart disease", "correct": false}, {"label": "C", "text": "Libman-Sacks endocarditis", "correct": false}, {"label": "D", "text": "Non-bacterial thrombotic carditis", "correct": false}], "correct_answer": "A. Infective endocarditis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/OjwtVbp6ouzJAnxTn62v1745218092.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:606px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Vegetations and site</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Rheumatic heart disease</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Small, <strong>warty, <span class=\"customMeta\" data-dictid=\"fc3d080799169277719904701c07f9\">sterile</span> </strong>vegetations along the line of <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> of <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> leaflets.</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Infective Endocarditis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Large, bulky, infected, friable, </strong>irregular mass along the line of <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> or on valvular cusps, more on the atrial side.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Non-bacterial Thrombotic Endocarditis</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Small, bland, <span class=\"customMeta\" data-dictid=\"fc3d080799169277719904701c07f9\">sterile</span> </strong>vegetation along the line of closure.</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Libman-Sacks Endocarditis</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Small or medium-sized <span class=\"customMeta\" data-dictid=\"fc3d080799169277719904701c07f9\">sterile</span> vegetations on <strong>either or both sides </strong>of valvular leaflets,<strong> most commonly on the lower side.</strong></p>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a patient who was admitted to the intensive care unit 48 hours after fracturing their femur, with a saturation of oxygen in the rebreathing unit at 100%, but their SpO 2 remained at 60%? The patient is also experiencing confusion, and a chest radiograph shows clear lung fields.", "options": [{"label": "A", "text": "Pulmonary embolism", "correct": false}, {"label": "B", "text": "Fat embolism", "correct": true}, {"label": "C", "text": "ARDS", "correct": false}, {"label": "D", "text": "Occult pneumothorax", "correct": false}], "correct_answer": "B. Fat embolism", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/991mnf9T9KC84AWH1AaP1745217891.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fat Embolism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fat <span class=\"customMeta\" data-dictid=\"1c07a1135f1692777187f547678386\">embolism</span> is a multi-organ disorder caused by fat globules entering the bloodstream, commonly occurring after high-risk <span class=\"customMeta\" data-dictid=\"0b8eb98a3f16927771945b310aec42\">orthopedic</span> injuries, <strong>particularly <span class=\"customMeta\" data-dictid=\"512283ec9816927772024c89478b7d\">femur</span> fractures.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Classic Triad</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hypoxia</li>\n<li>Petechiae</li>\n<li>Altered mental status</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Other Symptoms </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Tachycardia, fever, anemia, thrombocytopenia, <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> (e.g., tachypnea, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> acidosis).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Young adults</strong> (20-30 years): <strong>Long bone fractures</strong></li>\n<li><strong>Iatrogenic cause: </strong>Occurs after <span class=\"customMeta\" data-dictid=\"5b22285eec169277719026820db11c\">intramedullary</span> (IM) <span class=\"customMeta\" data-dictid=\"cb2d373f701692777193324602b6fa\">nailing</span> of the femur.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathogenesis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Following injury, fat from <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> or <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">platelet</span> <span class=\"customMeta\" data-dictid=\"36e1a07ab01692777180db73f01e84\">agglutination</span> enters injured vessels and travels as emboli, leading to various clinical manifestations.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Chest X-ray: </strong>Commonly clear lung fields, occasionally <strong>Snowstorm appearance is seen (pathognomonic)</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Arencibia, Yanetsy &amp; Vo, Mai &amp; Kinaga, Jennifer &amp; Uribe, Jorge &amp; Velasquez, Gloria &amp; Madruga, Mario &amp; Carlan, Steve.\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/CXR-showed-diffuse-bilateral-infiltrates-in-a-snowstorm-pattern_fig3_329820422\" data-tags=\"\" height=\"345\" src=\"https://image.prepladder.com/content/991mnf9T9KC84AWH1AaP1745217891.png\" width=\"388\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>PaO₂ &lt;60 mm Hg</strong></li>\n<li>Platelet count &lt;1.5 lakhs</li>\n<li><strong>ECG: </strong>Prominent S-wave</li>\n<li><strong>Other lab findings: </strong>Anemia, hypocalcemia</li>\n<li><strong>CT scan and MRI: </strong>Assess severity</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Respiratory support: </strong>Oxygen or <span class=\"customMeta\" data-dictid=\"072a58ab7d169277720130e58f9614\">ventilator</span> support to restore PaO₂</li>\n<li><strong>Drug therapy:</strong>\n<ul>\n<li><strong>Steroids: </strong>Reduce lung <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and improve gas exchange.</li>\n<li><strong>Heparin: </strong>Lipolytic and <span class=\"customMeta\" data-dictid=\"257da9409416927771815e64ee5df1\">antiplatelet</span> agent.</li>\n<li><strong>Low <span class=\"customMeta\" data-dictid=\"b2df2436bf1692777193d90e9c0132\">molecular weight</span> dextran: </strong>Increases <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> volume.</li>\n<li>Antibiotics and other supportive care.</li>\n</ul>\n</li>\n<li><strong>Definitive <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> treatment: </strong>Early <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> to prevent worsening.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the method of scoliosis measurement portrayed in the provided image?", "options": [{"label": "A", "text": "Cobb’s angle", "correct": true}, {"label": "B", "text": "Bohler’s angle", "correct": false}, {"label": "C", "text": "Ferguson angle", "correct": false}, {"label": "D", "text": "Baumann’s angle", "correct": false}], "correct_answer": "A. Cobb’s angle", "question_images": ["https://image.prepladder.com/notes/wi9TZfleNGna4Q0XOsRx1746444224.png"], "explanation_images": ["https://image.prepladder.com/content/04gNGaSKBnU4wd7oCUIm1745218278.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cobb’s angle</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Management</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt; 20<strong>°</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Observation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>20-60<strong>°</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bracing (Milwaukee brace)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;60<strong>°</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgical management</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cobb angle <strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Scoliosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bohler angle <strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Calcaneum</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ferguson angle <strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Kyphosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Baumann angle <strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elbow fracture</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Q angle</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Patella</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Kite angle</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CTEV (Congenital talipus equino varus)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Southwick angle</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>SCFE (Slipped capital <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> epiphysis)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a population study, if the mean value is 200 and the standard deviation is 20, what percentage of the population will fall within one standard deviation of the mean?", "options": [{"label": "A", "text": "180-220", "correct": true}, {"label": "B", "text": "160-240", "correct": false}, {"label": "C", "text": "170- 230", "correct": false}, {"label": "D", "text": "190-210", "correct": false}], "correct_answer": "A. 180-220", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 20-year-old patient presents with a history of malabsorption, diarrhea, and poor appetite. A duodenal biopsy shows crypt hyperplasia, villi atrophy, and CD8+ cells in the lamina propria. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Environmental enteropathy", "correct": false}, {"label": "B", "text": "Celiac disease", "correct": true}, {"label": "C", "text": "Whipple’s disease", "correct": false}, {"label": "D", "text": "Chronic pancreatitis", "correct": false}], "correct_answer": "B. Celiac disease", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/RplxumIjWNASgjfrQEHZ1746437953.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:626px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Celiac disease</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Definition </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Autoimmune disorder <span class=\"customMeta\" data-dictid=\"3978e9614f1692777200abbe4cfa34\">triggered</span> by ingesting gluten-containing foods in genetically <span class=\"customMeta\" data-dictid=\"55691242bb1692777199360f64cb67\">susceptible</span> individuals.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Synonym</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Gluten-sensitive enteropathy</li>\n<li>Celiac sprue</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Diagnosis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Biopsy of the second part of the <span class=\"customMeta\" data-dictid=\"280e59e9331692777186f3beac2c41\">duodenum</span> or <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> jejunum</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Serum markers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Anti-tissue <span class=\"customMeta\" data-dictid=\"4a47b71b801692777200d06df00a08\">transglutaminase</span> (tTG)-most sensitive</li>\n<li>Anti-endomysial antibodies (EMA)-most specific</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Histology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Increased <span class=\"customMeta\" data-dictid=\"74b2ee426f169277719000793323ba\">intraepithelial</span> <strong>CD8+ T lymphocytes </strong>(intraepithelial lymphocytosis),</li>\n<li><strong>Crypt hyperplasia</strong> (increased mitosis)</li>\n<li><strong>Villous atrophy</strong> (reduced mucosal surface area, causing malabsorption)</li>\n<li>Inflammatory cells infiltration</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The variation in a data set is compared with that of another data set using?", "options": [{"label": "A", "text": "Variance", "correct": false}, {"label": "B", "text": "Coefficient of variation", "correct": true}, {"label": "C", "text": "Standard error of mean", "correct": false}, {"label": "D", "text": "Standard deviation", "correct": false}], "correct_answer": "B. Coefficient of variation", "question_images": [], "explanation_images": [], "explanation": "<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 3-year-old child has been brought to the hospital with complaints of fever, rash, and swelling of her hands and feet for the past 5 days. There is desquamative skin rash, edema of hands and feet, erythema of palms and soles, oral erythema, and cervical lymphadenopathy. What is the likely condition?", "options": [{"label": "A", "text": "Kawasaki disease", "correct": true}, {"label": "B", "text": "Measles", "correct": false}, {"label": "C", "text": "Scarlet fever", "correct": false}, {"label": "D", "text": "Henoch-Schonlein purpura", "correct": false}], "correct_answer": "A. Kawasaki disease", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/CruhcCT59IerysqIFaKr1746438118.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "How is the calculation of one variable using another variable typically performed?", "options": [{"label": "A", "text": "Coefficient of correlation", "correct": false}, {"label": "B", "text": "Coefficient of Regression", "correct": true}, {"label": "C", "text": "Coefficient of variation", "correct": false}, {"label": "D", "text": "Coefficient of determination", "correct": false}], "correct_answer": "B. Coefficient of Regression", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B)\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A middle-aged woman presents with thyroid swelling. Blood tests show elevated TSH levels and the presence of thyroid peroxidase antibodies. Histopathological examination revealed the presence of Hurthle cells. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Hashimoto thyroiditis", "correct": true}, {"label": "B", "text": "Graves’ disease", "correct": false}, {"label": "C", "text": "Follicular carcinoma of thyroid", "correct": false}, {"label": "D", "text": "Medullary carcinoma of thyroid", "correct": false}], "correct_answer": "A. Hashimoto thyroiditis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/DHgzeC6cNTunYijv0K3V1745218825.png", "https://image.prepladder.com/notes/yWacePijOKX8LDa4Xzj41746438249.png", "https://image.prepladder.com/notes/RFKMByNhcs3aNqI76L6I1746438359.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What are the most reliable indicators for regular monitoring of air pollution?", "options": [{"label": "A", "text": "Sulfur dioxide, smoke, and suspended particles", "correct": true}, {"label": "B", "text": "Sulfur dioxide, lead, and particulate matter", "correct": false}, {"label": "C", "text": "Sulfur dioxide and carbon monoxide", "correct": false}, {"label": "D", "text": "Carbon monoxide and hydrogen sulfide", "correct": false}], "correct_answer": "A. Sulfur dioxide, smoke, and suspended particles", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 52-year-old male patient comes with complaints of abdominal pain, nausea, and vomiting. A peripheral blood smear reveals macrocytes and hypersegmented neutrophils, and an endoscopy reveals atrophic gastritis. Which of the following conditions is likely to be seen in this patient?", "options": [{"label": "A", "text": "Vitamin B12 deficiency", "correct": true}, {"label": "B", "text": "Folate deficiency", "correct": false}, {"label": "C", "text": "Pyridoxine deficiency", "correct": false}, {"label": "D", "text": "Niacin deficiency", "correct": false}], "correct_answer": "A. Vitamin B12 deficiency", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/0lXZv2jfSk6HdXUDtvaX1746438643.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Reduced Dietary Intake</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Increased demand</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Impaired Absorption</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Vegetarian diet</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pregnancy</li>\n<li>Lactation</li>\n<li>Growing child</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pernicious <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> (Option A)</li>\n<li>Infections- Diphyllobothrium latum (Option C)</li>\n<li>Gastrectomy (Option:D)</li>\n<li>Ileal disorders</li>\n<li>Malabsorption</li>\n<li>Ileal resection</li>\n<li>Diverticula of bowel</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Folic acid Deficiency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Vitamin B12 Deficiency</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Site of <span class=\"customMeta\" data-dictid=\"c66705291e1692777203ed3498a606\">folate</span> <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> - Jejunum</li>\n<li>Seen in: Alcoholics, pregnancy</li>\n<li>Causes <span class=\"customMeta\" data-dictid=\"b00388be25169277719369b3ab059f\">neural</span> tube defects</li>\n<li>Neurological symptoms are not seen</li>\n<li>Normal methylmalonic acid</li>\n<li>High homocysteine</li>\n<li>FIGLU test positive</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Site of <span class=\"customMeta\" data-dictid=\"c66705291e1692777203ed3498a606\">folate</span> <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> - Ileum</li>\n<li>Seen in: Vegetarians, pregnancy, Diphyllobothrium latum infection</li>\n<li>Neurological manifestation: Subacute combined degeneration</li>\n<li>High methylmalonic acid</li>\n<li>High homocysteine</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which variable determines the disparity in disease occurrence between individuals who have been exposed and those who have not been exposed?", "options": [{"label": "A", "text": "Relative risk", "correct": false}, {"label": "B", "text": "Attributable risk", "correct": true}, {"label": "C", "text": "Population Attributable risk", "correct": false}, {"label": "D", "text": "Odds Ratio", "correct": false}], "correct_answer": "B. Attributable risk", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What type of study is it when a person collects data on lung cancer patients from government hospitals and the corresponding number of cigarette packets sold during the same time period, in order to examine the relationship between smoking and lung cancer?", "options": [{"label": "A", "text": "Cross sectional", "correct": false}, {"label": "B", "text": "Ecological", "correct": true}, {"label": "C", "text": "Experimental", "correct": false}, {"label": "D", "text": "Quasi-experimental", "correct": false}], "correct_answer": "B. Ecological", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is true about the pathogenesis of Hirschsprung disease?", "options": [{"label": "A", "text": "Failure of migration of neural crest cells", "correct": true}, {"label": "B", "text": "Increase in ganglion cells", "correct": false}, {"label": "C", "text": "Visceral myopathy", "correct": false}, {"label": "D", "text": "Obstruction by inflammatory strictures", "correct": false}], "correct_answer": "A. Failure of migration of neural crest cells", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 24-year-old patient presented with swelling in the wrist joint. Histopathological examination of the swelling revealed spindle cells with palisading of the nuclei and Verocay bodies. Which of the following is the most likely condition?", "options": [{"label": "A", "text": "Schwannoma", "correct": true}, {"label": "B", "text": "Neurofibroma", "correct": false}, {"label": "C", "text": "Neuroma", "correct": false}, {"label": "D", "text": "Glioma", "correct": false}], "correct_answer": "A. Schwannoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Ooyp3bCV562AK3qjTzHJ1745219537.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Vaccine protocol followed after Disaster?", "options": [{"label": "A", "text": "Everyone is given diphtheria", "correct": false}, {"label": "B", "text": "Everyone is given tetanus toxoid", "correct": false}, {"label": "C", "text": "Everyone is given cholera vaccine", "correct": false}, {"label": "D", "text": "Only the health worker given cholera, typhoid, tetanus toxoid", "correct": true}], "correct_answer": "D. Only the health worker given cholera, typhoid, tetanus toxoid", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which compound is primarily responsible for the disinfectant properties of bleaching powder among the following options?", "options": [{"label": "A", "text": "Hypochlorite ion", "correct": false}, {"label": "B", "text": "Hydrochloric acid", "correct": false}, {"label": "C", "text": "Hypochlorous acid", "correct": true}, {"label": "D", "text": "Chloride ion", "correct": false}], "correct_answer": "C. Hypochlorous acid", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a 30-year-old female who presents with a tumor located at the knee joint, as shown in the provided biopsy-image?", "options": [{"label": "A", "text": "Osteosarcoma", "correct": false}, {"label": "B", "text": "Ewing’s Sarcoma", "correct": false}, {"label": "C", "text": "Giant cell tumour", "correct": true}, {"label": "D", "text": "Osteoblastoma", "correct": false}], "correct_answer": "C. Giant cell tumour", "question_images": ["https://image.prepladder.com/content/EDKfd6d6pUkyj03gTcMh1745219868.png"], "explanation_images": ["https://image.prepladder.com/content/g7xoftwUokm4hpPdT2ca1745219933.png", "https://image.prepladder.com/content/zuFurNwY3LPc2evAx8PW1745219940.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Benign but locally aggressive tumor of bone.<strong> </strong></li>\n<li>It commonly arises from epiphysis.</li>\n<li>MC Age: 20 and 45 years of age.</li>\n<li>Females &gt; males.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sites affected</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Distal <span class=\"customMeta\" data-dictid=\"512283ec9816927772024c89478b7d\">femur</span> &gt; Proximal <span class=\"customMeta\" data-dictid=\"ca6af868811692777200ce067e9db9\">tibia</span> &gt; Distal <span class=\"customMeta\" data-dictid=\"ec7c10c0421692777197d151a4c0b5\">radius</span> &gt; Sacrum</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Malignancy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Malignant transformation in &lt;1% of cases.</li>\n<li>Lungs are the most common site for metastases.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Swelling, vague pain.</li>\n<li>Pathological fracture.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>X-ray: Expansile <span class=\"customMeta\" data-dictid=\"897ef2d27c16927771861eb7f4726c\">eccentric</span> <span class=\"customMeta\" data-dictid=\"d54da38aaa1692777191560f60c0f9\">lytic</span> <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> on epiphysis</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Luu Hanh\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/giant-cell-tumour-with-secondary-aneurysmal-bone-cyst-3\" data-tags=\"\" height=\"602\" src=\"https://image.prepladder.com/content/g7xoftwUokm4hpPdT2ca1745219933.png\" width=\"541\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histo- pathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Multinucleated giant cells and a background network of spindle-shaped <span class=\"customMeta\" data-dictid=\"81ec3329d0169277719261f4b61d44\">mononuclear</span> stromal cells.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Nephron\" data-hash=\"\" data-license=\"CC-BY-SA-3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Giant_cell_tumour_of_bone_-_very_high_mag.jpg\" data-tags=\"\" height=\"381\" src=\"https://image.prepladder.com/content/zuFurNwY3LPc2evAx8PW1745219940.png\" width=\"569\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Extended <span class=\"customMeta\" data-dictid=\"f857ee35331692777185a5895e53b5\">curettage</span> with Bone grafting</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the likely cause for the complaints of a 9-year-old boy presenting with right ear pain, difficulty in opening the mouth, painful swallowing, and fever, when the oral cavity examination shows no abnormalities in the external facial examination?", "options": [{"label": "A", "text": "Pharyngitis", "correct": false}, {"label": "B", "text": "Parotid abscess", "correct": false}, {"label": "C", "text": "Bezold’s Abscess", "correct": false}, {"label": "D", "text": "Quinsy", "correct": true}], "correct_answer": "D. Quinsy", "question_images": ["https://image.prepladder.com/content/qIcoRXIvdxP6W4eKEA9F1745219997.png"], "explanation_images": [], "explanation": "<p>Correct Answer D - Qu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which vitamin, when infused in supraphysiological doses, causes macular edema and macular cysts?", "options": [{"label": "A", "text": "Vitamin A", "correct": false}, {"label": "B", "text": "Vitamin D", "correct": false}, {"label": "C", "text": "Vitamin E", "correct": false}, {"label": "D", "text": "Vitamin B3", "correct": true}], "correct_answer": "D. Vitamin B3", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "B-cells are induced to produce IgE by which of the following?", "options": [{"label": "A", "text": "IL-2", "correct": false}, {"label": "B", "text": "IL-4", "correct": true}, {"label": "C", "text": "IL-1", "correct": false}, {"label": "D", "text": "IL-6", "correct": false}], "correct_answer": "B. IL-4", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Interleukins</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Role</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>IL-4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Key <span class=\"customMeta\" data-dictid=\"0ac01cc0c31692777185cae5f28175\">cytokine</span> in driving the allergic response</li>\n<li>Enhances Ig E-mediated reaction</li>\n<li><strong>Stimulates B cells to undergo class switching to IgE</strong> and promotes the expansion of Th2 cells</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>IL-5</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Development and <span class=\"customMeta\" data-dictid=\"ba6b77f29316927771807350f86ce2\">activation</span> of eosinophils→ Recruited to the site of <span class=\"customMeta\" data-dictid=\"7396dd35a41692777181bd7038fa9b\">allergen</span> exposure→ Release <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> mediators and enzymes→ Tissue damage and inflammation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>IL-13</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Amplifies <span class=\"customMeta\" data-dictid=\"a54166a5961692777189c5557f61f3\">IgE</span> production</li>\n<li>Acts on epithelial cells to stimulate <span class=\"customMeta\" data-dictid=\"ab75ea330616927771938a64f8ebd6\">mucus</span> secretion</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>IL-10</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Anti-inflammatory cytokine</li>\n<li>Inhibits <span class=\"customMeta\" data-dictid=\"0ac01cc0c31692777185cae5f28175\">cytokine</span> production by Th1 cells and macrophages.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A graft from an identical twin is called:", "options": [{"label": "A", "text": "Allograft", "correct": false}, {"label": "B", "text": "Autograft", "correct": false}, {"label": "C", "text": "Isograft", "correct": true}, {"label": "D", "text": "Xenograft", "correct": false}], "correct_answer": "C. Isograft", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:716px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:1px solid #0d0d0d; vertical-align:bottom\">\n<p><strong>Type of Graft</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:1px solid #0d0d0d; vertical-align:bottom\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none\">\n<p><strong>Autograft (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:none\">\n<p>An organ or tissue is taken from an individual and grafted on him/ herself.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none\">\n<p><strong>Isograft</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:none\">\n<p>Grafts between genetically identical individuals, such as identical twins</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none\">\n<p><strong>Allograft (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:none\">\n<p>Graft between two genetically non-identical members of the same species (e.g. organ transplants between two non-identical and <span class=\"customMeta\" data-dictid=\"8baf7b24c316927771847e2b2ae466\">compatible</span> individuals.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none\">\n<p><strong>Xenograft (Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:none\">\n<p>Graft from one species to another (e.g., pig skin is a temporary <span class=\"customMeta\" data-dictid=\"02f0c206e716927771999e45b2d63b\">substitute</span> for burn treatment).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:none; border-top:none\">\n<p><strong>Synthetic Graft</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #0d0d0d; border-left:1px solid #0d0d0d; border-right:1px solid #0d0d0d; border-top:none\">\n<p>Artificial materials or bioengineered constructs replace or support damaged tissue (e.g., artificial skin substitutes, <span class=\"customMeta\" data-dictid=\"c293dda462169277718335b755e1a9\">bone graft</span> substitutes).</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Nitric oxide is synthesized from:", "options": [{"label": "A", "text": "L-Arginine", "correct": true}, {"label": "B", "text": "L-Citrulline", "correct": false}, {"label": "C", "text": "Glycine", "correct": false}, {"label": "D", "text": "Lysine", "correct": false}], "correct_answer": "A. L-Arginine", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the name of the surgical procedure performed to enlarge the cartilaginous segment of the outer ear canal?", "options": [{"label": "A", "text": "Meatoplasty", "correct": true}, {"label": "B", "text": "Tympanoplasty", "correct": false}, {"label": "C", "text": "Myringoplasty", "correct": false}, {"label": "D", "text": "Otoplasty", "correct": false}], "correct_answer": "A. Meatoplasty", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - M\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Replacing alanine by which amino acid, will increase the UV absorbance of protein at 280nm wavelength?", "options": [{"label": "A", "text": "Leucine", "correct": false}, {"label": "B", "text": "Proline", "correct": false}, {"label": "C", "text": "Arginine", "correct": false}, {"label": "D", "text": "Tryptophan", "correct": true}], "correct_answer": "D. Tryptophan", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Stimulation of which of the following causes cough when the external acoustic canal is scratched?", "options": [{"label": "A", "text": "Auriculotemporal nerve", "correct": false}, {"label": "B", "text": "Auricular branch of vagus", "correct": true}, {"label": "C", "text": "Great auricular nerve", "correct": false}, {"label": "D", "text": "Facial nerve", "correct": false}], "correct_answer": "B. Auricular branch of vagus", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - &lt;span class=\"customMeta\" data-dictid=\"e825a1e928169277718206e4709c41\"&gt;Auricular&lt;/span&gt; branch of vagu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following features does the histology of the reperfused myocardium show?", "options": [{"label": "A", "text": "Wavy fibres", "correct": false}, {"label": "B", "text": "Neutrophils in cardiac muscle", "correct": false}, {"label": "C", "text": "Swelling of cells", "correct": false}, {"label": "D", "text": "Eosinophilic contraction band", "correct": true}], "correct_answer": "D. Eosinophilic contraction band", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/WHLb5SlHwNPvUeN1N5qh1746438905.png", "https://image.prepladder.com/notes/qbsV8wnsUo0Vnmm6mvls1746439338.png", "https://image.prepladder.com/notes/xtuXr8HsZRobY5vpOYUf1746439661.png", "https://image.prepladder.com/notes/ucN69SfUl8r5mwV8NFKa1746439812.png", "https://image.prepladder.com/notes/RnJRBMINeTgN0xfJrclr1746439933.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:720px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Time </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Gross Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Light Microscope</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Electron Microscope</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Reversible Injury</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>0– 1/2 hour</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Relaxation of myofibrils; <span class=\"customMeta\" data-dictid=\"2e2aa646ab1692777188e3eb8286d8\">glycogen</span> loss; mitochondrial swelling</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Irreversible Injury</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1/2 –4 hours</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Usually none; variable waviness of fibres at the border; <span class=\"customMeta\" data-dictid=\"4d740152f5169277719373f5cf60e6\">myocyte</span> vacuolisation</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"PA206\" data-author=\"Katarzyna Michaud, Cristina Basso, Giulia d’Amati, Carla Giordano, Ivana Kholová, Stephen D. Preston, Stefania Rizzo, Sara Sabatasso, Mary N. Sheppard, Aryan Vink, Allard C. van der Wal &amp; on behalf of the Association for European Cardiovascular Pathology (AECVP)\" data-hash=\"11895\" data-license=\"CC BY 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Histopathology_of_myofiber_waviness_in_myocardial_infarction.jpg\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/qbsV8wnsUo0Vnmm6mvls1746439338.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sarcolemmal disruption;</p>\n<p>mitochondrial <span class=\"customMeta\" data-dictid=\"837f5783cf1692777181d8a586fd8c\">amorphous</span> densities (Calcium in mitochondria)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4–12 hours</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Occasional dark mottling</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Early <span class=\"customMeta\" data-dictid=\"d25e3f25ed169277718419e6bab67a\">coagulative</span> necrosis, oedema, haemorrhage</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>12–24 hours</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dark mottling</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ongoing <span class=\"customMeta\" data-dictid=\"d25e3f25ed169277718419e6bab67a\">coagulative</span> necrosis; <span class=\"customMeta\" data-dictid=\"bf97c6fd301692777196300645cf12\">pyknosis</span> of nuclei; <span class=\"customMeta\" data-dictid=\"4d740152f5169277719373f5cf60e6\">myocyte</span> hypereosinophilia; marginal</p>\n<p>contraction band necrosis; early <span class=\"customMeta\" data-dictid=\"041f0e547a1692777193350b3f7d39\">neutrophilic</span> infiltrate</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1–3 days</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mottling with yellow-tan infarct</p>\n<p>centre</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Coagulative necrosis, with loss of <span class=\"customMeta\" data-dictid=\"e6b47028191692777193eb698e43b6\">nuclei</span> and striations; brisk <span class=\"customMeta\" data-dictid=\"f46ba26d111692777190def3b1d80a\">interstitial</span> <span class=\"customMeta\" data-dictid=\"8fd5e2898d16927771900855b98180\">infiltrate</span> of neutrophils (Acute inflammation)</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"PA207\" data-author=\"NA\" data-hash=\"11900\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Acute_myocardial_infarction_with_coagulative_necrosis_(4).JPG\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/xtuXr8HsZRobY5vpOYUf1746439661.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3–7 days</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hyperemic border; central</p>\n<p>yellow-tan softening</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Beginning <span class=\"customMeta\" data-dictid=\"4b47ea9a2816927771864d1b0a12f9\">disintegration</span> of dead myofibers, with dying neutrophils; early <span class=\"customMeta\" data-dictid=\"aa86b61bdd1692777195ea42ef0356\">phagocytosis</span> of dead cells by macrophages at the <span class=\"customMeta\" data-dictid=\"7d8fbc62391692777190399f2b0126\">infarct</span> border (Chronic inflammation)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>7–10 days</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Maximally yellow-tan and soft, with depressed red-tan margins</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Well-developed <span class=\"customMeta\" data-dictid=\"aa86b61bdd1692777195ea42ef0356\">phagocytosis</span> of dead cells; <span class=\"customMeta\" data-dictid=\"09e414c5a71692777188ef029aefe5\">granulation</span> tissue at margins (Repair)</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"PA208 \" data-author=\"Katarzyna Michaud, Cristina Basso, Giulia d’Amati, Carla Giordano, Ivana Kholová, Stephen D. Preston, Stefania Rizzo, Sara Sabatasso, Mary N. Sheppard, Aryan Vink, Allard C. van der Wal &amp; on behalf of the Association for European Cardiovascular Pathology (AECVP)\" data-hash=\"11903\" data-license=\"CC BY 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Histopathology_of_granulation_tissue_with_formation_of_microvessels_in_myocardial_infarction.jpg\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/ucN69SfUl8r5mwV8NFKa1746439812.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>10–14 days</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Red-gray depressed <span class=\"customMeta\" data-dictid=\"7d8fbc62391692777190399f2b0126\">infarct</span> borders</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Well-established <span class=\"customMeta\" data-dictid=\"09e414c5a71692777188ef029aefe5\">granulation</span> tissue with new blood vessels and <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">collagen</span> deposition</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2–8 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Grey-white scar, progressive from the border toward the core of the infarct</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">collagen</span> deposition, with decreased cellularity</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt;2 months</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Scarring complete</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dense <span class=\"customMeta\" data-dictid=\"79dbeeeba41692777184e63d6d214e\">collagenous</span> scar</p>\n<figure class=\"caption_element\"><img alt=\"PA209\" data-author=\"Katarzyna Michaud, Cristina Basso, Giulia d’Amati, Carla Giordano, Ivana Kholová, Stephen D. Preston, Stefania Rizzo, Sara Sabatasso, Mary N. Sheppard, Aryan Vink, Allard C. van der Wal &amp; on behalf of the Association for European Cardiovascular Pathology (AECVP)\" data-hash=\"11906\" data-license=\"CC BY 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Histopathology_of_dense_fibrous_scar_replacing_myocyte_loss_in_myocardial_infarction.jpg\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/RnJRBMINeTgN0xfJrclr1746439933.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The process of apolipoprotein B48 synthesis involves which of the following?", "options": [{"label": "A", "text": "RNA alternate splicing", "correct": false}, {"label": "B", "text": "RNA editing", "correct": true}, {"label": "C", "text": "DNA editing", "correct": false}, {"label": "D", "text": "RNA interference", "correct": false}], "correct_answer": "B. RNA editing", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All-trans retinoic acid (ATRA) is used in the treatment of tumours associated with which of the following genetic aberrations?", "options": [{"label": "A", "text": "PML-RARA", "correct": true}, {"label": "B", "text": "BCR-ABL", "correct": false}, {"label": "C", "text": "cMYC", "correct": false}, {"label": "D", "text": "RUNX1-ETO", "correct": false}], "correct_answer": "A. PML-RARA", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/q878Tr4dJu3wxYNi6UCU1746440043.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A person who met with an accident and suffered from a skull fracture presents with the following finding. Identify this clinical finding.", "options": [{"label": "A", "text": "Battle sign", "correct": true}, {"label": "B", "text": "Bezold abscess", "correct": false}, {"label": "C", "text": "Mastoiditis", "correct": false}, {"label": "D", "text": "Griesinger sign", "correct": false}], "correct_answer": "A. Battle sign", "question_images": ["https://image.prepladder.com/content/meIgSBVRWY8hwwWeGwtC1745220868.png"], "explanation_images": [], "explanation": "<p>Correct Answer A - Battle sig\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a patient with obstructive jaundice, which of the following outcomes may be observed in Van der Bergh's reaction?", "options": [{"label": "A", "text": "Direct positive", "correct": true}, {"label": "B", "text": "Indirect positive", "correct": false}, {"label": "C", "text": "Both positive", "correct": false}, {"label": "D", "text": "Coproporphyrin", "correct": false}], "correct_answer": "A. Direct positive", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 12-year-old child presented with 15 days of cough. On examination, cervical lymphadenopathy was noted, and the lymph node biopsy showed the following features. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Tuberculosis", "correct": true}, {"label": "B", "text": "Leprosy", "correct": false}, {"label": "C", "text": "Sarcoidosis", "correct": false}, {"label": "D", "text": "Syphilis", "correct": false}], "correct_answer": "A. Tuberculosis", "question_images": ["https://image.prepladder.com/content/65eJsKvjG4lu7wy1DU1F1745220973.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:621px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Type of Granuloma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Examples</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Caseating Granuloma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Tuberculosis, Histoplasmosis, Coccidioidomycosis, <strong>Syphilis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Non-caseating Granuloma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Sarcoidosis</strong>, Crohn’s disease, <strong>Leprosy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Foreign Body Granuloma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Silicosis, Asbestos-related diseases, Foreign body reactions</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Immune Granuloma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Wegener’s granulomatosis, Giant cell arteritis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Durck’s Granuloma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Cerebral malaria</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Stellate Granuloma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Cat scratch disease</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which is the enzyme activated by a decrease in insulin: glucagon ratio?", "options": [{"label": "A", "text": "Glucokinase", "correct": false}, {"label": "B", "text": "Hexokinase", "correct": false}, {"label": "C", "text": "Phosphoructokinase", "correct": false}, {"label": "D", "text": "Glucose 6-phosphatase", "correct": true}], "correct_answer": "D. Glucose 6-phosphatase", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following views involves an X-ray beam angled at 45° to the orbitomeatal line is also known as?", "options": [{"label": "A", "text": "Water’s view", "correct": true}, {"label": "B", "text": "Towne’s view", "correct": false}, {"label": "C", "text": "Law’s view", "correct": false}, {"label": "D", "text": "Stenver’s view", "correct": false}], "correct_answer": "A. Water’s view", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - Water’s v\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is true regarding competitive inhibition?", "options": [{"label": "A", "text": "The inhibitor binds to an allosteric site on the enzyme.", "correct": false}, {"label": "B", "text": "Competitive inhibition decreases the apparent Vmax (maximum reaction rate) of the enzyme.", "correct": false}, {"label": "C", "text": "Increasing substrate concentration can overcome competitive inhibition.", "correct": true}, {"label": "D", "text": "Competitive inhibition decreases the Km for the substrate", "correct": false}], "correct_answer": "C. Increasing substrate concentration can overcome competitive inhibition.", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/hq1O2ef7wA2PguA3b7g11746451315.png", "https://image.prepladder.com/notes/oMrKsigWVMM89hrFylca1746451506.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Competitive inhibitors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Correlation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Methotrexate and <span class=\"customMeta\" data-dictid=\"0f9fe95f081692777186e5071229c6\">Dihydrofolate</span> Reductase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Methotrexate acts as a competitive <span class=\"customMeta\" data-dictid=\"b5fb56a28b1692777190396ae8b625\">inhibitor</span> by mimicking dihydrofolate, the natural <span class=\"customMeta\" data-dictid=\"385d52533a169277719991c090c3d7\">substrate</span> of DHFR, and binding to its active site, thereby preventing <span class=\"customMeta\" data-dictid=\"0f9fe95f081692777186e5071229c6\">dihydrofolate</span> from binding and inhibiting the enzyme's activity.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sulfa Drugs and PABA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sulfa drugs, such as sulfanilamide, competitively <span class=\"customMeta\" data-dictid=\"6b3de87b7c16927771901326efbcd2\">inhibit</span> the <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> dihydropteroate <span class=\"customMeta\" data-dictid=\"d2bd91ccac169277719941254e1795\">synthase</span> by mimicking <span class=\"customMeta\" data-dictid=\"2840845b5b16927771946abe018ef6\">para-aminobenzoic acid</span> (PABA), a <span class=\"customMeta\" data-dictid=\"385d52533a169277719991c090c3d7\">substrate</span> involved in <span class=\"customMeta\" data-dictid=\"778971b8f5169277720391773cc8fa\">folic acid</span> <span class=\"customMeta\" data-dictid=\"3fda45538a1692777199ec2a5478a5\">synthesis</span> in bacteria.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ethanol and Alcohol Dehydrogenase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ethanol can act as a competitive <span class=\"customMeta\" data-dictid=\"b5fb56a28b1692777190396ae8b625\">inhibitor</span> of <span class=\"customMeta\" data-dictid=\"c578fa95fe16927771927ea57020f0\">methanol</span> <span class=\"customMeta\" data-dictid=\"5b1a045f5f169277719210c0ac7a1e\">metabolism</span> by competing for the <span class=\"customMeta\" data-dictid=\"08c37b57da1692777180a39e8239fb\">active site</span> of alcohol dehydrogenase. This is used in cases of <span class=\"customMeta\" data-dictid=\"c578fa95fe16927771927ea57020f0\">methanol</span> poisoning.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Captopril and <span class=\"customMeta\" data-dictid=\"881411ec321692777181ca707f2515\">Angiotensin-Converting Enzyme</span> (ACE)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Captopril competes with the natural <span class=\"customMeta\" data-dictid=\"385d52533a169277719991c090c3d7\">substrate</span> of ACE, thereby inhibiting the production of <span class=\"customMeta\" data-dictid=\"c4d00ed86c1692777181c0c43a452a\">angiotensin</span> II, a <span class=\"customMeta\" data-dictid=\"53172b32401692777195efbbb6b2e8\">peptide</span> that increases blood pressure.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old woman with a long history of dyspnea, chronic cough with sputum, and wheezing died of respiratory failure following a bout of lobar pneumonia. She was not a smoker or an alcoholic. The lung at autopsy is shown in the image below. Which of the following is most likely to cause the pathological changes shown?", "options": [{"label": "A", "text": "Alpha-1 antitrypsin deficiency", "correct": true}, {"label": "B", "text": "Cystic fibrosis", "correct": false}, {"label": "C", "text": "Mutation in dynein arms", "correct": false}, {"label": "D", "text": "Antibodies against type-IV collagen", "correct": false}], "correct_answer": "A. Alpha-1 antitrypsin deficiency", "question_images": ["https://image.prepladder.com/notes/7qELtq81is575ZgRko2h1746440947.png"], "explanation_images": ["https://image.prepladder.com/notes/0jnXeK2sdgmd3zF5rnbt1746440342.png", "https://image.prepladder.com/notes/8qzMTH6Dam5NLMvF0glk1746440649.png", "https://image.prepladder.com/notes/8IfqZBKTwctQ7niDlby31746440495.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:637px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Centriacinar (M/C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Panacinar</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Paraseptal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Irregular</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Involves</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Proximal acinus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Proximal &amp; <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> acini</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Distal acinus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Irregular involvement</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Site</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Upper lobes, especially <span class=\"customMeta\" data-dictid=\"c6223a27fb169277718147405290e1\">apical</span> segments</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lower zones &amp; <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> margins of the lung.</p>\n<p>More severe at the base of the lung.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The upper half of the lungs (more severe).</p>\n<p> </p>\n<p>Airspaces can <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> cyst-like structures.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Any part of the lung can be involved.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Aetiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Smokers</p>\n<p>Chronic bronchitis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>α1-antitrypsin deficiency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Spontaneous pneumothorax</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Depends on involvement, most found in autopsy</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What does a correlation coefficient of less than 0.5 signify?", "options": [{"label": "A", "text": "Confidence interval of 95%", "correct": false}, {"label": "B", "text": "Weak correlation", "correct": true}, {"label": "C", "text": "Not statistically significant", "correct": false}, {"label": "D", "text": "Strong correlation", "correct": false}], "correct_answer": "B. Weak correlation", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 2-year-old child presented with the following X-ray finding. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Acute laryngotracheobronchitis", "correct": true}, {"label": "B", "text": "Acute epiglottitis", "correct": false}, {"label": "C", "text": "Acute pharyngitis", "correct": false}, {"label": "D", "text": "Parapharyngeal abscess", "correct": false}], "correct_answer": "A. Acute laryngotracheobronchitis", "question_images": ["https://image.prepladder.com/notes/QQ1EGLr9zHM71v5RE7tR1746450383.png"], "explanation_images": ["https://image.prepladder.com/notes/RcPKhDgR0TgzCZHlXif71746450507.png", "https://image.prepladder.com/notes/z4nfuexAKzHJ8jqOVI1K1746450455.png"], "explanation": "<p>Correct Answer A - &lt;span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\"&gt;Acute&lt;/span&gt; laryngotracheobronchitis:</p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Acute Epiglottitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Croup (Acute Laryngotracheobronchitis)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align:center\"><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Visualisation: Red and swollen <span class=\"customMeta\" data-dictid=\"7056fd87c916927771872a0a0c6ece\">epiglottis</span> (avoid <span class=\"customMeta\" data-dictid=\"2f73e160ba1692777190d65065c95b\">indirect</span> <span class=\"customMeta\" data-dictid=\"4c11fea2841692777191286556aceb\">laryngoscopy</span> to prevent <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> obstruction).</li>\n<li>Lateral Neck X-ray: \"Thumb sign\" indicating swollen epiglottis.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Differentiated based on clinical features (e.g., absence of drooling, voice quality).</li>\n<li>The \"steeple sign\" on an X-ray <span class=\"customMeta\" data-dictid=\"603878db1116927771812fecb63aec\">AP</span> view shows a narrowing of the upper airway, often seen in croup.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align:center\"><strong>X-Ray Imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"EN310\" data-author=\"Niknejad M, Sharma R, Bell D\" data-hash=\"12059\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/thumb-sign-epiglottitis-1?lang=gb\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/RcPKhDgR0TgzCZHlXif71746450507.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"EN424\" data-author=\"Frank Gaillard,\" data-hash=\"12058\" data-license=\"CC BY SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Steeple_sign#/media/File:Croup_steeple_sign.jpg\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/z4nfuexAKzHJ8jqOVI1K1746450455.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align:center\"><strong>Hospitalisation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Required due to the high risk of <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> obstruction.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Often necessary due to potential breathing difficulties.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align:center\"><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Antibiotics: Parenteral administration (e.g., ampicillin, third-generation cephalosporins).</li>\n<li>Steroids: Hydrocortisone or <span class=\"customMeta\" data-dictid=\"1b969bdd951692777186a2a131511d\">dexamethasone</span> to reduce oedema.</li>\n<li>Hydration: IV fluids if needed.</li>\n<li>Humidified Oxygen: Via mist tent or croupette.</li>\n<li>Intubation or Tracheostomy: In cases of severe <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> obstruction.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Antibiotics: <span class=\"customMeta\" data-dictid=\"e1a1f4fa35169277718150f74fa895\">Ampicillin</span> 50 mg/kg/day against the H. <span class=\"customMeta\" data-dictid=\"c3817918b816927771902d2176d0c8\">influenza</span> virus.</li>\n<li>Humidification: Helps clear crusts and thick secretions that block the <span class=\"customMeta\" data-dictid=\"869f194fb11692777200fc402d40af\">tracheobronchial</span> tree.</li>\n<li>Steroids: to reduce oedema.</li>\n<li>Racemic Epinephrine: Used as a bronchodilator.</li>\n<li>Intubation or Tracheostomy: Considered if <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> worsens or lasts beyond 72 hours. </li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 34-year-old male was on maize as a staple diet for a prolonged period. He presented with diarrhea and lesion over his neck as shown in the image below. The condition occurs due to deficiency of:", "options": [{"label": "A", "text": "Niacin", "correct": true}, {"label": "B", "text": "Vitamin B12", "correct": false}, {"label": "C", "text": "Vitamin D", "correct": false}, {"label": "D", "text": "Iron", "correct": false}], "correct_answer": "A. Niacin", "question_images": ["https://image.prepladder.com/content/opfLp93v3RbH3qirkyj31745221425.png"], "explanation_images": ["https://image.prepladder.com/content/e4Fxawd9AOCaytmVf1q71745221478.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most likely cause of the worsening neurological symptoms in a 30-year-old woman who presented with complaints of fatigue, difficulty breathing during exertion, weight loss, and frequent falls, and was found to have bilateral decrease in vibration sense, a hemoglobin level of 8.2 g% with high MCV, and was initially treated with folate which improved her anemia?", "options": [{"label": "A", "text": "Folate is not well absorbed", "correct": false}, {"label": "B", "text": "Folic acid therapy unmasked pyridoxine deficiency.", "correct": false}, {"label": "C", "text": "Deficiency of folate reductase in CNS.", "correct": false}, {"label": "D", "text": "Folate therapy caused rapid use of vitamin B12 stores aggravating symptoms.", "correct": true}], "correct_answer": "D. Folate therapy caused rapid use of vitamin B12 stores aggravating symptoms.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/1zQciakscj2viNwCPcwG1745221669.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The family pedigree chart is given below. Identify the mode of inheritance of this condition.", "options": [{"label": "A", "text": "Autosomal dominant", "correct": true}, {"label": "B", "text": "Autosomal recessive", "correct": false}, {"label": "C", "text": "X-linked dominant", "correct": false}, {"label": "D", "text": "X-linked recessive", "correct": false}], "correct_answer": "A. Autosomal dominant", "question_images": ["https://image.prepladder.com/notes/udN9NhsB5vWegBkOg8xx1746441057.png"], "explanation_images": ["https://image.prepladder.com/notes/udN9NhsB5vWegBkOg8xx1746441057.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mnemonic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Disease</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>He</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>H</strong>ereditary spherocytosis</li>\n<li><strong>H</strong>ereditary hemorrhagic telangiectasia</li>\n<li><strong>H</strong>ereditary non-polyposis <span class=\"customMeta\" data-dictid=\"f04bf2125316927771847bfe139191\">colorectal</span> cancer (HNPCC/Lynch syndrome)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Has</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>H</strong>untington’s disease</li>\n<li><strong>H</strong>ypertrophic cardiomyopathy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>A </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>A</strong>utosomal dominant <span class=\"customMeta\" data-dictid=\"ba336eb30516927771960f9d9bd85c\">polycystic</span> <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Very</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Von Willebrand disease</strong></li>\n<li><strong>V</strong>on Hippel Lindau syndrome</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dominant</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>D</strong>ystonia myotonica</li>\n<li><strong>O</strong>steogenesis imperfecta</li>\n<li><strong>M</strong>arfan’s syndrome</li>\n<li><strong>I</strong>ntermittent porphyria</li>\n<li><strong>N</strong>F-1 &amp; 2</li>\n<li><strong>A</strong>chondroplasia</li>\n<li><strong>N</strong>oonan syndrome</li>\n<li><strong>T</strong>uberous sclerosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Powerful</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>P</strong>seudohypoparathyroidism</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Father</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>F</strong>amilial <span class=\"customMeta\" data-dictid=\"bf1f32fbd81692777180c0d2485ab2\">adenomatous</span> polyposis</li>\n<li>Li <strong>F</strong>raumeni syndrome</li>\n<li><strong>F</strong>amilial hypercholesterolemia</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which investigation yields the most precise prognostic information for predicting the risk of perioperative cardiac complications among the options provided?", "options": [{"label": "A", "text": "Exercise ECG testing", "correct": false}, {"label": "B", "text": "Dobutamine stress echocardiography", "correct": true}, {"label": "C", "text": "Myocardial perfusion scintigraphy", "correct": false}, {"label": "D", "text": "Coronary angiography", "correct": false}], "correct_answer": "B. Dobutamine stress echocardiography", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What could be the probable reason for the observed result in the capnograph of a patient who is intubated and undergoing controlled ventilation?", "options": [{"label": "A", "text": "Esophageal intubation", "correct": false}, {"label": "B", "text": "Inspiration with cardiac oscillations", "correct": false}, {"label": "C", "text": "Bronchospasm", "correct": false}, {"label": "D", "text": "Spontaneous respiratory effort", "correct": true}], "correct_answer": "D. Spontaneous respiratory effort", "question_images": ["https://image.prepladder.com/content/yLuqpeiBl6OiEKM2H5iB1745222050.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old female presents with chest pain, recurrent heartburn, and dysphagia. A barium swallow shows a bird beak sign. Which of the following statements is true regarding the condition in this patient?", "options": [{"label": "A", "text": "Relaxation of LES", "correct": false}, {"label": "B", "text": "Increased peristalsis", "correct": false}, {"label": "C", "text": "Decreased release of NO and VIP in the distal esophagus", "correct": true}, {"label": "D", "text": "Decreased tone of LES", "correct": false}], "correct_answer": "C. Decreased release of NO and VIP in the distal esophagus", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient is given a nicotinic receptor antagonist as a muscle relaxant. Which drug is given postoperatively to recover from muscle weakness?", "options": [{"label": "A", "text": "Physostigmine", "correct": false}, {"label": "B", "text": "Neostigmine", "correct": true}, {"label": "C", "text": "Carbachol", "correct": false}, {"label": "D", "text": "Succinylcholine", "correct": false}], "correct_answer": "B. Neostigmine", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is correct about Huntington's chorea?", "options": [{"label": "A", "text": "It is a trinucleotide repeat disorder", "correct": true}, {"label": "B", "text": "There is a loss of function type of mutation", "correct": false}, {"label": "C", "text": "There are abnormal length repeats of CUG", "correct": false}, {"label": "D", "text": "Abnormality is seen due to a defect in chromosome 6", "correct": false}], "correct_answer": "A. It is a trinucleotide repeat disorder", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:659px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Trinucleotide Repeat</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Gene</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Chromosome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Huntington's Disease</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>CAG</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>HTT (Huntingtin)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>4p16.3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Fragile X Syndrome</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>CGG</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>FMR1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Xq27.3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Myotonic Dystrophy</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>CTG</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>DMPK</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>19q13.3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Friedreich Ataxia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>GAA</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>FXN</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>9q21.1</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A deceased male was brought to the morgue for a post-mortem examination. His relatives reported that he had a tattoo over his skin, which was not found on examination. Which of the following structures would you examine?", "options": [{"label": "A", "text": "Lymph nodes", "correct": true}, {"label": "B", "text": "Liver", "correct": false}, {"label": "C", "text": "Arteries", "correct": false}, {"label": "D", "text": "Skin", "correct": false}], "correct_answer": "A. Lymph nodes", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age of tattoo</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Firm union, reddish/bluish scar: 5-6 days</li>\n<li>Pale, soft and sensitive (tender): 2 weeks-2 months</li>\n<li>Tough, brownish, glistening, wrinkled and little tender: 2-6 months</li>\n<li>Tough, white, glistening and non-tender: &gt; 6 months</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dyes Used</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Common dyes: Indigo, cobalt, carbon, vermilion, cadmium, selenium, <span class=\"customMeta\" data-dictid=\"6ee66a5d5d16927771966f1ea457eb\">Prussian blue</span> and Indian ink</li>\n<li>Black, blue and red dyes are most commonly employed</li>\n<li>Depth of penetration: 50-3000 times a minute</li>\n<li>Pigment can migrate to nearby <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes <strong>(Option C)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Erasure Methods</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgical methods:</strong></p>\n<ul>\n<li>Dermabrasion (e.g., tannic acid, silver nitrate, trichloroacetic acid)</li>\n<li>Complete <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> and skin grafting</li>\n</ul>\n<p><strong>Non-surgical methods:</strong></p>\n<ul>\n<li>Production of burns by means of red hot iron</li>\n<li>Scarification</li>\n<li>Using <span class=\"customMeta\" data-dictid=\"c32b3a9fac16927771831530888fdf\">carbon dioxide</span> snow</li>\n<li>Electrolysis</li>\n<li>Caustic or <span class=\"customMeta\" data-dictid=\"16a98a214c16927771852d7f6c344e\">corrosive</span> substances</li>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"cfcf3a19b2169277718637c5eb0e74\">eczema</span> may cause tattoo designs to disappear</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In relation to the punishment of perjury, which specific section of the IPC addresses this matter?", "options": [{"label": "A", "text": "191", "correct": false}, {"label": "B", "text": "192", "correct": false}, {"label": "C", "text": "193", "correct": true}, {"label": "D", "text": "197", "correct": false}], "correct_answer": "C. 193", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>BNS 227/ Section 191 </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Giving false evidence/statement under <span class=\"customMeta\" data-dictid=\"7ba028341716927771941e1dc3b066\">oath</span> by a witness (Perjury)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>BNS 228/ Section 192 </strong><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fabrication of evidence</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>BNS 229/ IPC 193 </strong><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Punishment for providing false evidence under <span class=\"customMeta\" data-dictid=\"7ba028341716927771941e1dc3b066\">oath</span> (Punishment for perjury) (imprisonment of upto 7 years + fine)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>BNS 234/ Section 197 </strong><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Punishment for issuing a false certificate (imprisonment of upto 7 years + fine)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>BNS 238</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Punishment for disappearance of vital evidence (imprisonment of upto 7 years + fine)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>BNS 239</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intentional omission of vital information by person legally <span class=\"customMeta\" data-dictid=\"d82fcb9d1f16927771836a9f6ccf14\">bound</span> to inform</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the OPD, a 5-year-old child presenting with a past medical record of perianal pain is examined. Upon testing a sample obtained from the perianal region, it reveals the presence of yellow rhombic crystals of spermine picrate. What is the specific diagnostic procedure used to identify this condition?", "options": [{"label": "A", "text": "Barberio test", "correct": true}, {"label": "B", "text": "Florence test", "correct": false}, {"label": "C", "text": "Takayama test", "correct": false}, {"label": "D", "text": "Teichmann test", "correct": false}], "correct_answer": "A. Barberio test", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/q26DLvztHuaKHh1Zz5Gi1745223165.png", "https://image.prepladder.com/content/KvC08DQHSF9Ghlr2pmMl1745223171.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Test Name</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Substance Detected</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Result</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Reagent Used</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Mnemonic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Notes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Barberio Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Spermine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Yellow needle-shaped crystals of <span class=\"customMeta\" data-dictid=\"d2dcd7d96c169277719967dfef3e51\">Spermine</span> Picrate</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Picric acid</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Barbar picks your hair with a needle</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Detects <span class=\"customMeta\" data-dictid=\"d2dcd7d96c169277719967dfef3e51\">Spermine</span> from the prostate; confirms the presence of seminal fluid.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Florence Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Choline</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Dark brown rhombic crystals of <span class=\"customMeta\" data-dictid=\"ad6984dc581692777184936c84dd97\">Choline</span> iodide</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>KI (Potassium Iodide)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Florence has 'C', C for Choline</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>It detects <span class=\"customMeta\" data-dictid=\"ad6984dc581692777184936c84dd97\">choline</span> from the <span class=\"customMeta\" data-dictid=\"c78e813e3a1692777198261357cb13\">seminal vesicle</span> and is used to identify seminal fluid.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Typically, what is the condition of the hymen in cases of sexual assault involving a young child?", "options": [{"label": "A", "text": "Ruptured since it is located superficially", "correct": false}, {"label": "B", "text": "Ruptured since it is very thin", "correct": false}, {"label": "C", "text": "Unruptured since it is deeply situated", "correct": true}, {"label": "D", "text": "Unruptured since it is highly elastic", "correct": false}], "correct_answer": "C. Unruptured since it is deeply situated", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child who is a victim under the POCSO Act is brought to the Department of forensic medicine for age estimation. The X-ray image of the hand is shown below. What is the likely age of the child?", "options": [{"label": "A", "text": "4 years", "correct": false}, {"label": "B", "text": "7 years", "correct": false}, {"label": "C", "text": "10 years", "correct": false}, {"label": "D", "text": "13 years", "correct": true}], "correct_answer": "D. 13 years", "question_images": ["https://image.prepladder.com/notes/jNqX7Jst4YHWRDllLV9Y1746449928.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Upper Limb</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Centers of Ossification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Age of Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Age of Fusion</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"7\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Humerus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Head</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>1 year</p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>At 5–6 years, the three <span class=\"customMeta\" data-dictid=\"30bdb5481f1692777203cbadf50a71\">fuse</span> together (conjoint epiphysis), and at 17–18 years, <span class=\"customMeta\" data-dictid=\"30bdb5481f1692777203cbadf50a71\">fuse</span> with the shaft.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Greater tubercle</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>3 years</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Lesser tubercle</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>5 years</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Capitulum</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>1 year</p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>At 14–15 years, all three fuses with the shaft</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Trochlea</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>9–10 years</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Lateral epicondyle</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>10–11 years</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Medial epicondyle</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>5–6 years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>16 years</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Radius</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Upper end</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>5–6 years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>15–17 years</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Lower end</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>1–2 years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>17–19 years</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Ulna</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Upper end</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>8–9 years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>15–17 years</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Lower end</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>5–6 years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>17–19 years</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Carpals</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Pisiform</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>9–12 years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Other Carpals</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>The <span class=\"customMeta\" data-dictid=\"e1b4bf3b7916927771838d6915860b\">capitate</span> and <span class=\"customMeta\" data-dictid=\"67cb40545f16927771882e55a0620e\">hamate</span> bones ossify during infancy, with the <span class=\"customMeta\" data-dictid=\"e1b4bf3b7916927771838d6915860b\">capitate</span> appearing first at 36th week(3-4 months age). Between ages 2 and 6, the number of visible <span class=\"customMeta\" data-dictid=\"c8a21e01261692777183ccc5569251\">carpal</span> bones on an X-ray roughly corresponds to the child's age (e.g., 3 <span class=\"customMeta\" data-dictid=\"c8a21e01261692777183ccc5569251\">carpal</span> bones indicate approximately 3 years old).</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Please determine the medication utilized for the management of the presented medical condition:", "options": [{"label": "A", "text": "Anti-fungal therapy", "correct": false}, {"label": "B", "text": "Anti-tubercular therapy", "correct": true}, {"label": "C", "text": "Topical steroids therapy", "correct": false}, {"label": "D", "text": "Anti-leprosy treatment", "correct": false}], "correct_answer": "B. Anti-tubercular therapy", "question_images": ["https://image.prepladder.com/notes/Jd3V79Phs8AMTl5TMK7l1746450697.png"], "explanation_images": ["https://image.prepladder.com/notes/PAu2uBr9PeMdRkomOkTW1746450812.png", "https://image.prepladder.com/content/H3YDaEJE2HFoeF0enVWE1745224103.png", "https://image.prepladder.com/notes/Jd3V79Phs8AMTl5TMK7l1746450697.png", "https://image.prepladder.com/content/OB55xhTGKi5KTG1g1qGF1745224118.png", "https://image.prepladder.com/content/qRytHhJhaJZfmL9y9GsY1745224124.png", "https://image.prepladder.com/content/XfvRtbC0NiClQxdk8mMW1745224130.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Exogenous:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Endogenous:</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Source of MTB is from outside the body</li>\n<li>First exposure to TB - new to TB infection is Naive infection\n\t\t\t\t<ul>\n<li>Called TB chance</li>\n<li>No immunity</li>\n</ul>\n</li>\n<li>Once had TB but now recurred due to Exogenous causes:\n\t\t\t\t<ul>\n<li>Tuberculosis Verrucous <span class=\"customMeta\" data-dictid=\"255bc104431692777185a0f4bdc3c9\">cutis</span> (TBVC)</li>\n<li>Immunity present</li>\n</ul>\n</li>\n</ul>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Source is within the body</li>\n<li>Transmitted to skin by:\n\t\t\t\t<ul>\n<li>Contiguous (ex: <span class=\"customMeta\" data-dictid=\"4fb6bd90f016927771918d4a2993ed\">lymphatic</span> TB breaking into skin) - Scrofuloderma</li>\n<li>Hematogenous - <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">Lupus</span> vulgaris, TB <span class=\"customMeta\" data-dictid=\"400d6b8b361692777188e33820bd85\">gumma</span> and <span class=\"customMeta\" data-dictid=\"de0ef5a95116927771922f41d2b8b5\">miliary</span> TB</li>\n<li>Auto <span class=\"customMeta\" data-dictid=\"de0ef5a95116927771922f41d2b8b5\">miliary</span> TB</li>\n<li>Auto <span class=\"customMeta\" data-dictid=\"4d839b33ba16927771902944bde5b4\">inoculation</span> - or Orificial TB</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1. TB Chancre / Primary <span class=\"customMeta\" data-dictid=\"4d839b33ba16927771902944bde5b4\">Inoculation</span> TB</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"DM178\" data-author=\" Kaliaperumal Karthikeyan Saravanan Gowtham Palaniappan Vijayasankar\" data-hash=\"12069\" data-license=\"CC BY NC 4.0\" data-source=\"https://www.researchgate.net/figure/A-single-well-defined-11-cm-ulcer-with-undermined-edges-and-violaceous-borders-floored_fig1_367223270\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/PAu2uBr9PeMdRkomOkTW1746450812.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p>2. TBVC or <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">Tuberculosis</span> verrucosa cutis</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Anupam Varshney Tarang Goyal\" data-hash=\"\" data-license=\"CC BY NC ND\" data-source=\"https://www.researchgate.net/figure/Tuberculosis-verruca-cutis-showing-verrucous-hyperkeratotic-warty-lesions-on-the-feet_fig5_50395564\" data-tags=\"\" height=\"251\" src=\"https://image.prepladder.com/content/H3YDaEJE2HFoeF0enVWE1745224103.png\" width=\"318\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1. <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">Lupus</span> Vulgaris</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"DM189\" data-author=\"Mary Thomas , Meryl Antony\" data-hash=\"12068\" data-license=\"NA\" data-source=\"https://www.semanticscholar.org/paper/Cutaneous-lupus-vulgaris%3A-Bringing-the-wolf-out-of-Thomas-Antony/a89b2e59b1e16f5f1a86f10218f43ffb849f9ae6\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/Jd3V79Phs8AMTl5TMK7l1746450697.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Ravikiran SP, Jaiswal AK, Syrti C, Madan Mohan NT, Aradhya SS\" data-hash=\"\" data-license=\"CC BY-NC-SA 3.0\" data-source=\"https://openi.nlm.nih.gov/detailedresult?img=PMC4886588_IDOJ-7-174-g002&amp;req=4\" data-tags=\"\" height=\"258\" src=\"https://image.prepladder.com/content/OB55xhTGKi5KTG1g1qGF1745224118.png\" width=\"321\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p>Apple <span class=\"customMeta\" data-dictid=\"88bc2baef31692777190f5b09925aa\">jelly</span> nodules on diascopy</p>\n<p>2. Scrofuloderma</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\" Mohammad2018\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Scrofuloderma.jpg\" data-tags=\"\" height=\"494\" src=\"https://image.prepladder.com/content/qRytHhJhaJZfmL9y9GsY1745224124.png\" width=\"298\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p>3. Orificial Tuberculosis</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Arzu Kılıç MD, Ülker Gül MD, Müzeyyen Gönül MD, Seçil Soylu MD, Seray Külcü Çakmak MD, Murat Demiriz MD\" data-hash=\"\" data-license=\"NA\" data-source=\"https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-4632.2009.03942.x\" data-tags=\"\" height=\"282\" src=\"https://image.prepladder.com/content/XfvRtbC0NiClQxdk8mMW1745224130.png\" width=\"295\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the finding shown in the image below:", "options": [{"label": "A", "text": "Herpes labialis", "correct": true}, {"label": "B", "text": "Herpangina", "correct": false}, {"label": "C", "text": "Molluscum contagiosum", "correct": false}, {"label": "D", "text": "Impetigo", "correct": false}], "correct_answer": "A. Herpes labialis", "question_images": ["https://image.prepladder.com/content/xPtBCnQDdyBfFhA8qig61745226511.png"], "explanation_images": [], "explanation": "\n<p><strong>References:</strong></p>\n<ul><li>↳ Reference:</li></u\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most probable diagnosis for a child born with membranes around the body, ectropion, and eclabium, presenting with lesions on the face, trunk, and extremities, and brought to the OPD, what is the diagnosis?", "options": [{"label": "A", "text": "Harlequin ichthyosis", "correct": true}, {"label": "B", "text": "Lamellar ichthyosis", "correct": false}, {"label": "C", "text": "Bathing suit ichthyosis", "correct": false}, {"label": "D", "text": "Ichthyosis vulgaris", "correct": false}], "correct_answer": "A. Harlequin ichthyosis", "question_images": ["https://image.prepladder.com/content/cymSQgwAKhXEOKQ2cXSN1745226718.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Subtype</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Genetic Defect</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Harlequin ichthyosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thick, plate-like scales covering the entire body</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>ABCA12 gene mutations</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lamellar <span class=\"customMeta\" data-dictid=\"a82fef21131692777189b6cfd6aff1\">ichthyosis</span> <strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Large thick scales, often present at birth</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>TGM1, ALOX12B, ALOXE3, or NIPAL4 gene mutations</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Congenital <span class=\"customMeta\" data-dictid=\"b2ae46fdc1169277718976f2230722\">ichthyosiform</span> <span class=\"customMeta\" data-dictid=\"b6563739731692777187bd27cb8d61\">erythroderma</span> (CIE)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Generalized redness, fine white scales</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>TGM1, ALOX12B, ALOXE3, or NIPAL4 gene mutations</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Self-healing <span class=\"customMeta\" data-dictid=\"f8503ae5301692777184fa9be44510\">collodion</span> baby</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Membrane-like encasement at birth, followed by shedding</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>TGM1, ALOX12B, ALOXE3, or NIPAL4 gene mutations</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Harlequin ichthyosis-like phenotypes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Variations resembling <span class=\"customMeta\" data-dictid=\"b94ff22ffd1692777188f1a126c399\">harlequin</span> ichthyosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Different genetic mutations, including PNPLA1, CYPF22, CASP14, CERS3, etc.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Under the Mental Healthcare Act 2017, what is the longest duration for which an individual can voluntarily admit themselves for mental health treatment?", "options": [{"label": "A", "text": "48 hours", "correct": false}, {"label": "B", "text": "7 days", "correct": false}, {"label": "C", "text": "30 days", "correct": true}, {"label": "D", "text": "90 days", "correct": false}], "correct_answer": "C. 30 days", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - 30 days:</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Admission of patients with <span class=\"customMeta\" data-dictid=\"e644108b4816927771929dda431b8e\">mental illness</span> according to the Mental Healthcare Act 2017</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Section 85</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Admission of a person with <span class=\"customMeta\" data-dictid=\"e644108b4816927771929dda431b8e\">mental illness</span> as an independent patient in a mental health establishment.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Section 86</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Independent admission and treatment.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Section 87</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Admission of minors.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Section 88</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Discharge of independent patients.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Section 89</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Supported admission:</strong></p>\n<ul>\n<li>An individual who requires admission due to threats or attempts of bodily harm to themselves or others or who is unable to care for themselves and has lost the capacity to make decisions regarding their mental healthcare or treatment.</li>\n<li>A nominated representative can provide consent for the admission.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Section 90</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Supported admission beyond 30 days.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female patient from the northeastern part of the country presents with progressive swelling of the upper limb. She has a history of coronary artery disease and underwent percutaneous coronary intervention. Examination reveals proximal limb swelling more than distal. What is the next best step in management?", "options": [{"label": "A", "text": "Echocardiography", "correct": false}, {"label": "B", "text": "Night blood test for worms", "correct": true}, {"label": "C", "text": "Duplex venous scan of limbs", "correct": false}, {"label": "D", "text": "ECG", "correct": false}], "correct_answer": "B. Night blood test for worms", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/IAtAZS1LAyCxBfA5ET9L1745227069.png", "https://image.prepladder.com/notes/H4kJMoDq82WAVixiAKOF1746446156.png", "https://image.prepladder.com/content/psAEs33nll9porTe8xAs1745227113.png", "https://image.prepladder.com/content/bHDOwQ5Ic7XnflTcFcQp1745227113.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Wuchereria bancrofti</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Brugia malayi </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Length </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>250 - 300 μm</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>175 - 230 μm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Appearance </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Graceful, sweeping curves</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Kinky, with secondary curves</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Nuclear column</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Discrete nuclei</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Blurred</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cephalic space</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Length and <span class=\"customMeta\" data-dictid=\"c6a728793d1692777183f8bab2d772\">breadth</span> equal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Almost twice as long as broad</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tail tip</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pointed, free of nuclei</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Two distinct <span class=\"customMeta\" data-dictid=\"e6b47028191692777193eb698e43b6\">nuclei</span> are at the tip</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Excretory <span class=\"customMeta\" data-dictid=\"7cff82458316927771965eba1af4db\">pore</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Not prominent</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Prominent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sheath </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Faintly-stained</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Well-stained</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mode of Infection </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bite of Culex, Anopheles or Aedes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bite of Mansonia or Anopheles</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Infective stage </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Third-stage <span class=\"customMeta\" data-dictid=\"7212bc0b761692777202ff3be51de7\">filariform</span> larva</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Habitat </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lymphatics</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Image </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"317\" src=\"https://image.prepladder.com/content/psAEs33nll9porTe8xAs1745227113.png\" width=\"314\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"278\" src=\"https://image.prepladder.com/content/bHDOwQ5Ic7XnflTcFcQp1745227113.png\" width=\"278\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following drug abuses can lead to the symptoms described by a 25-year-old male patient who complains of a sensation resembling insects crawling beneath his skin and has presented to the clinic?", "options": [{"label": "A", "text": "Cannabis", "correct": false}, {"label": "B", "text": "Cocaine", "correct": true}, {"label": "C", "text": "Heroin", "correct": false}, {"label": "D", "text": "Alcohol", "correct": false}], "correct_answer": "B. Cocaine", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/AIrgtXaq0CEWCEQDRl0a1746433990.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Cocaine </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Origin </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Leaves of Erythroxylum coca</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"FM131\" data-author=\" Enn1.jpg: Dbotany derivative work: Ilmari Karonen\" data-hash=\"11818\" data-license=\"CC BY SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Coca#/media/File:Erythroxylum_novogranatense_var._Novogranatense_(retouched).jpg\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/AIrgtXaq0CEWCEQDRl0a1746433990.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p>Erythroxylum <span class=\"customMeta\" data-dictid=\"442d1d735b16927771847e0cbbd1ca\">coca</span> plant</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Local names </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Coke, snow, Cadillac, White lady</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Physical properties</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Colourless, odourless, crystalline, bitter taste</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism of action</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>It is a potent central nervous system (CNS) <span class=\"customMeta\" data-dictid=\"bec9bb02501692777199b0f75e340e\">stimulant</span> that produces initial <span class=\"customMeta\" data-dictid=\"41b8036e5416927771870abd5bdbc2\">euphoria</span> and increased energy, followed by depression as its effects wear off.</li>\n<li>It enhances alertness and activity while stimulating the <span class=\"customMeta\" data-dictid=\"bd1c98736616927771820954b0a744\">autonomic</span> nervous system, leading to increased heart rate and elevated blood pressure.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Route of administration </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Snorting, Smoking, IV injection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Signs of abuse</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Septal perforation</li>\n<li>Crack hands (multiple blackened, hyperkeratotic lesions on the fingers and palms).</li>\n<li>Black <span class=\"customMeta\" data-dictid=\"3b007026bd16927771997ae809b603\">staining</span> of tongue and teeth</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Effects </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Stages </strong></p>\n<p><strong>1. Stage of excitement </strong></p>\n<ul>\n<li>Feeling of well-being</li>\n<li>Loss of depression and fatigue</li>\n<li>Excited and restless</li>\n<li>Tingling sensation in hands and feet</li>\n<li><strong>Increased heart rate</strong></li>\n<li>Increase in temperature</li>\n<li>Rapid and deep respiration</li>\n</ul>\n<p> </p>\n<p><strong>2. Stage of depression</strong></p>\n<ul>\n<li>Profuse perspiration</li>\n<li>Convulsion</li>\n<li>Reduced <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> rate</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Cardiac arrhythmia</li>\n<li>Cardiac failure</li>\n<li>Cardiovascular collapse</li>\n<li>Cerebrovascular accident</li>\n<li>Aortic dissection</li>\n<li>Myocardial infarction</li>\n<li>Skin necrosis</li>\n<li>Intracerebral hemorrhage</li>\n<li>Formication (Cocaine Bugs)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management of fatal dose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Maintain airway, breathing and circulation</li>\n<li>If ingested: Gastric <span class=\"customMeta\" data-dictid=\"b625b3e881169277719169ef4e1af3\">lavage</span> with <strong>potassium permanganate</strong></li>\n<li>If snorted, <strong>Wash the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"26080f047a169277719334625cadef\">mucous</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> with water</strong></li>\n<li>If injected: <strong>Ligature</strong> over the <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">injection</span> site</li>\n<li><strong>Amyl <span class=\"customMeta\" data-dictid=\"8866b36aa016927771938ffb10b429\">nitrite</span> </strong>via <span class=\"customMeta\" data-dictid=\"0b1500fcd816927771900b59d16bde\">inhalation</span> route</li>\n<li><strong>Thiamine 100 mg IV injection</strong></li>\n<li><strong>Naloxone <span class=\"customMeta\" data-dictid=\"eef118d8f31692777189e54df45163\">hydrochloride</span> 2mg IV <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">injection</span> </strong></li>\n<li>Symptomatic management for convulsions using <strong>barbiturates</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old woman presented with post–menopausal bleeding. Ultrasonography revealed a mass with a “feeding vessel”, as shown in the image below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Fibroid uterus", "correct": false}, {"label": "B", "text": "Endometrial polyp", "correct": true}, {"label": "C", "text": "Endometrial carcinoma", "correct": false}, {"label": "D", "text": "Leiomyosarcoma", "correct": false}], "correct_answer": "B. Endometrial polyp", "question_images": ["https://image.prepladder.com/content/Y7vZp5rJZp6D6tNWynEP1745227159.png"], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 22-year-old presents with high-grade fever, confusion, and a purpuric rash. CSF analysis reveals gram-negative diplococci. What is the most likely etiology?", "options": [{"label": "A", "text": "Neisseria meningitidis", "correct": true}, {"label": "B", "text": "Pseudomonas aeruginosa", "correct": false}, {"label": "C", "text": "Streptococcus pneumoniae", "correct": false}, {"label": "D", "text": "E. coli", "correct": false}], "correct_answer": "A. Neisseria meningitidis", "question_images": ["https://image.prepladder.com/notes/71mZIFKUcu56nt8lz4cf1746446514.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:537px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Investigation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cerebrospinal Fluid (CSF) Analysis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cloudy or purulent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>White Blood Cell Count (WBC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated (pleocytosis), typically &gt;1,000 cells/µL, with predominance of neutrophils</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Protein</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Glucose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreased</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gram Stain</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Presence of <span class=\"customMeta\" data-dictid=\"08cb2b02c81692777188b83845c84c\">gram-negative</span> diplococci</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Culture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Growth of Neisseria meningitidis on chocolate <span class=\"customMeta\" data-dictid=\"2c294889fb169277718046e4ef230c\">agar</span> or Thayer-Martin agar</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Polymerase Chain Reaction (PCR)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Detection of Neisseria meningitidis DNA</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Latex Agglutination Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Positive for Neisseria meningitidis antigens</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Blood Tests</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Culture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Growth of Neisseria meningitidis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>White Blood Cell Count</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated <span class=\"customMeta\" data-dictid=\"515cde208f1692777191112bb2ff9e\">leukocytosis</span> with left shift</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:663px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Neisseria meningitidis treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Empirical <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">Antibiotic</span> Therapy</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Ceftriaxone or Cefotaxime</strong>: First-line treatment for suspected bacterial meningitis, including Neisseria meningitidis.</li>\n<li><strong>Vancomycin</strong>: Added to cover potential penicillin-resistant Streptococcus pneumoniae until <span class=\"customMeta\" data-dictid=\"ed4634701d16927771942c4408495f\">pathogen</span> identification.</li>\n<li><strong>Ampicillin</strong>: Added if Listeria monocytogenes is suspected, particularly in <span class=\"customMeta\" data-dictid=\"a3cc9f976916927771895692a1a8a0\">immunocompromised</span> patients and the elderly.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definitive Therapy</strong></p>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Penicillin G:</strong> First choice for confirmed Neisseria meningitidis, given intravenously.</li>\n<li><strong>Alternative Antibiotics: Continue Ceftriaxone or Cefotaxime</strong> if <span class=\"customMeta\" data-dictid=\"ed4634701d16927771942c4408495f\">pathogen</span> is susceptible.</li>\n<li><strong>Duration: Typically lasts 7 days.</strong></li>\n<li><strong>Dexamethasone</strong>: May be used to reduce <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and neurological complications, especially if started before or with the first <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> dose.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Chemoprophylaxis for Close Contacts</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Rifampin</strong>: <strong>600 mg every 12 hours for 2 days (adults); 10 mg/kg every 12 hours for 2 days (children).</strong></li>\n<li><strong>Ciprofloxacin</strong>: Single dose of 500 mg (adults); not typically used in children.</li>\n<li><strong>Ceftriaxone</strong>: Single <span class=\"customMeta\" data-dictid=\"8a99f9c37f16927771902daa814697\">intramuscular</span> dose of 250 mg (adults) or 125 mg (children).</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Vaccination Prophylaxis</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Meningococcal <span class=\"customMeta\" data-dictid=\"aea912322316927771960b320d4f65\">polysaccharide</span> vaccines </strong>(serogroups A, C, Y, W135): 2 doses for children aged 3-18 months or a single dose for older children and adults.</li>\n<li>Not given to children less than 2-3 years of age.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Indications for Vaccination</strong></p>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Contacts during outbreaks</li>\n<li>Splenic dysfunction</li>\n<li>Terminal <span class=\"customMeta\" data-dictid=\"f0ff39a3fa1692777184cf743ca1e7\">complement</span> component deficiency</li>\n<li>International travelers</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:720px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Parameter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Bacterial Meningitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Viral (Aseptic) Meningitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Fungal Meningitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Tuberculous Meningitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cloudy or purulent</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clear or slightly cloudy</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clear or slightly cloudy</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clear or slightly cloudy, Cob web coagulum</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>White Blood Cell Count</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Elevated (usually &gt;1,000 cells/µL)</li>\n<li>Predominantly neutrophils (≥80%)</li>\n</ul>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Elevated (usually 50-1,000 cells/µL)</li>\n<li>Predominantly lymphocytes</li>\n</ul>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Elevated (usually 20-500 cells/µL)</li>\n<li>Predominantly lymphocytes</li>\n</ul>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Elevated (usually 50-500 cells/µL)</li>\n<li>Predominantly lymphocytes</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Protein</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated (100-500 mg/dL)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mildly elevated or normal (50-100 mg/dL)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated (100-500 mg/dL)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated (100-500 mg/dL)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Glucose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreased (&lt;40 mg/dL or &lt;2.2 mmol/L)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal or slightly decreased</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreased</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreased</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CSF/Blood Glucose Ratio</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&lt;0.4</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt;0.6</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&lt;0.4</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&lt;0.4</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Opening Pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal or slightly elevated</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gram Stain</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Positive for bacteria (gram-negative diplococci, etc.)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Negative</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Negative</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Negative</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Characteristic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Neisseria gonorrhoeae</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Neisseria meningitidis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Morphology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gram-negative diplococci</p>\n<p>Kidney shaped</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gram-negative <span class=\"customMeta\" data-dictid=\"32537c6fb21692777186a27701e42b\">diplococci</span> with capsule</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Oxidase Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Positive</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Positive</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Catalase Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Positive</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Positive</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Habitat</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Human <span class=\"customMeta\" data-dictid=\"2fd33fb2ac16927771889901daadeb\">genitourinary</span> tract</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Human nasopharynx</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Transmission</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sexual contact</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Respiratory droplets, close contact</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Diseases Caused</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gonorrhea, <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> disease, <span class=\"customMeta\" data-dictid=\"6ce77d5f5e1692777185cf7f8a67cd\">conjunctivitis</span> in newborns</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Meningitis, <span class=\"customMeta\" data-dictid=\"afd363657e16927771982285d861d6\">septicemia</span> (meningococcemia)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Virulence Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pili, outer <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> proteins, lipooligosaccharides (LOS)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Polysaccharide capsule, pili, outer <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> proteins, LOS</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Culture Media</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Thayer-Martin agar, Chocolate agar</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Thayer-Martin agar, Chocolate agar</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Carbohydrate Utilization</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Glucose positive, <span class=\"customMeta\" data-dictid=\"8ea673008d1692777191f46338fc58\">maltose</span> negative</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Glucose positive, <span class=\"customMeta\" data-dictid=\"8ea673008d1692777191f46338fc58\">maltose</span> positive</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Superoxol Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Strong positive with 30% <span class=\"customMeta\" data-dictid=\"11f7bcb8da16927771898e93932195\">hydrogen</span> peroxide</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Weak or negative reaction</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Antibiotic Resistance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increasing resistance, especially to <span class=\"customMeta\" data-dictid=\"7f576b591a1692777195da1639d0fe\">penicillin</span> and fluoroquinolones</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Generally <span class=\"customMeta\" data-dictid=\"55691242bb1692777199360f64cb67\">susceptible</span> to penicillin, but resistance can occur</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Vaccination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No vaccine available</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Vaccines available for various serogroups (A, C, W, Y, B)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Epidemiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common STD worldwide</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Causes outbreaks, especially in crowded settings</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In what procedure is the instrument shown in the image utilized?", "options": [{"label": "A", "text": "Punch Biopsy", "correct": false}, {"label": "B", "text": "Tubectomy (Female Sterilization)", "correct": true}, {"label": "C", "text": "Bone marrow biopsy set", "correct": false}, {"label": "D", "text": "Trocar and cannula for laparoscopy", "correct": false}], "correct_answer": "B. Tubectomy (Female Sterilization)", "question_images": ["https://image.prepladder.com/notes/o5gSX08CGVSVxLni2zFq1746445066.png"], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tubectomy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surgical procedure for permanent female sterilization</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Purpose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>To permanently prevent pregnancy by <span class=\"customMeta\" data-dictid=\"9dc12b322016927771830dff673eeb\">blocking</span> or sealing the <span class=\"customMeta\" data-dictid=\"efc83dab2c1692777202b5d1d06c4f\">fallopian</span> tubes, preventing <span class=\"customMeta\" data-dictid=\"8dc15ef09e1692777198320917e46b\">sperm</span> from reaching the eggs</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Method</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Laparoscopic <span class=\"customMeta\" data-dictid=\"2a6989bad01692777201a73b82b799\">Tubectomy</span> (Mini-Laparotomy):</strong> Performed using a <span class=\"customMeta\" data-dictid=\"3eccf9024e1692777191308aaef628\">laparoscope</span> and small incisions to access and block/seal the <span class=\"customMeta\" data-dictid=\"efc83dab2c1692777202b5d1d06c4f\">fallopian</span> tubes.</p>\n<p><strong>Tubectomy:</strong> Performed through a small <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> in the <span class=\"customMeta\" data-dictid=\"ac388c59831692777180f5a8e12913\">abdomen</span> to access and block/seal the <span class=\"customMeta\" data-dictid=\"efc83dab2c1692777202b5d1d06c4f\">fallopian</span> tubes.</p>\n<p><strong>Postpartum <span class=\"customMeta\" data-dictid=\"a970a38e85169277720171bea632e7\">Tubal</span> Ligation: </strong>Performed immediately after <span class=\"customMeta\" data-dictid=\"51b378d6031692777184a20aa31718\">childbirth</span> (cesarean section or <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> delivery) when the woman is still in the hospital.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anesthesia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>General <span class=\"customMeta\" data-dictid=\"e24b7bd55d16927771818aaa6ad0ed\">anesthesia</span> or local <span class=\"customMeta\" data-dictid=\"e24b7bd55d16927771818aaa6ad0ed\">anesthesia</span> with sedation, depending on the specific procedure and the patient's condition</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Recovery Time</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Varies depending on the technique used and the individual patient, but typically a few days to a week</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Effectiveness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Highly effective in preventing pregnancy, but a small risk of pregnancy exists, usually due to failure in completely blocking/sealing the <span class=\"customMeta\" data-dictid=\"efc83dab2c1692777202b5d1d06c4f\">fallopian</span> tubes.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Potential Side Effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pain or discomfort at the <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> site - Infection or <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> - Injury to surrounding organs (rare) - Rarely, <span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\">ectopic</span> pregnancy (pregnancy outside the uterus) may occur</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Reversal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tubal <span class=\"customMeta\" data-dictid=\"dcfb6667ee1692777191f00c3df2df\">ligation</span> <span class=\"customMeta\" data-dictid=\"82343f61171692777197b4a08bc719\">reversal</span> (tubal reanastomosis) is possible but success rates vary. It is a complex procedure and may not always result in restored fertility.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Alternative Options</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Other <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">reversible</span> <span class=\"customMeta\" data-dictid=\"ec56ec0a50169277718538a912cf18\">contraception</span> methods such as oral <span class=\"customMeta\" data-dictid=\"a13cdc2a8a1692777185da87f2ff85\">contraceptive</span> pills, <span class=\"customMeta\" data-dictid=\"1d5d2712dc169277719050154d38a1\">intrauterine</span> devices (IUDs), implants, and barrier methods.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The patient exhibited an enlarged lymph node in the inguinal area. The primary cause that is most probable is", "options": [{"label": "A", "text": "Testicular cancer", "correct": false}, {"label": "B", "text": "Anal cancer", "correct": true}, {"label": "C", "text": "Sigmoid colon cancer", "correct": false}, {"label": "D", "text": "Prostate cancer", "correct": false}], "correct_answer": "B. Anal cancer", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/I61u8ui2LMhz0YrtjEYI1745227528.png", "https://image.prepladder.com/content/qFSXGXXKjZ2ElTVPA9DV1745227528.png"], "explanation": "<p>Correct Option B) Anal cancer</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Region</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Lymphatic Drainage</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Upper half of the rectum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inferior mesenteric nodes via <span class=\"customMeta\" data-dictid=\"fd17d69e761692777194318fd673aa\">pararectal</span> and <span class=\"customMeta\" data-dictid=\"9008060dc21692777198e329f5be75\">sigmoid</span> nodes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lower half of the <span class=\"customMeta\" data-dictid=\"9b9c4c412f1692777197ed217e7373\">rectum</span> &amp; upper anal canal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Internal <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> nodes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Anal <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> (below the <span class=\"customMeta\" data-dictid=\"6f87bfc5af1692777195908802d86b\">pectinate</span> line)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Superficial inguinal <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What medication is typically prescribed to treat the condition experienced by a 25-year-old woman who complains of a sensation resembling creepy crawling in her legs? This symptom is more pronounced at night and hinders her ability to sleep. However, she finds relief by either engaging in walking or moving her legs.", "options": [{"label": "A", "text": "Gabapentin", "correct": true}, {"label": "B", "text": "Pramipexole", "correct": false}, {"label": "C", "text": "Vitamin B12", "correct": false}, {"label": "D", "text": "Iron tablets", "correct": false}], "correct_answer": "A. Gabapentin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - Gabapentin</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Restless Legs Syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Explanation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>It is<strong> </strong>also known as <strong>Willis-Ekbom Disease </strong>and is characterised by an uncomfortable sensation in the legs, especially in the evening or at night, which leads to an irresistible urge to move them.</li>\n<li>The movement temporarily relieves the discomfort, but the symptoms soon return, causing difficulty falling asleep or maintaining sleep.</li>\n<li>This leads to insomnia, which is a common complaint in patients with RLS.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Sensations that begin after rest</li>\n<li>Relief of discomfort with movement</li>\n<li>Worsening of symptoms at night with a distinct symptom-free period in the early morning</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>No definite cure, but symptoms can be managed.</li>\n<li>Movement of affected limbs may provide temporary relief.</li>\n<li>Treat underlying conditions like <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> neuropathy, diabetes, or iron <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> anaemia to control symptoms.</li>\n</ul>\n<p> </p>\n<p><strong>Medications:</strong></p>\n<ul>\n<li><strong>Iron supplements</strong>: For RLS <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to iron deficiency. <strong>(Option D ruled out)</strong></li>\n<li><strong>Anti-seizure drugs</strong> (first-line treatment):\n\t\t\t\t<ul>\n<li>FDA-approved: <strong>Gabapentin, enacarbil</strong>, and others like <strong>pregabalin</strong>.</li>\n</ul>\n</li>\n<li><strong>Dopaminergic agents</strong>:\n\t\t\t\t<ul>\n<li>FDA-approved: <strong>Ropinirole, pramipexole, rotigotine</strong>. <strong>(Option A ruled out)</strong></li>\n<li><strong>Levodopa + carbidopa</strong> are used intermittently.</li>\n</ul>\n</li>\n<li><strong>Opioids</strong>: For severe cases unresponsive to other drugs (e.g., <strong>methadone, oxycodone</strong>).</li>\n<li><strong>Benzodiazepines</strong>: For better sleep (<strong>clonazepam, lorazepam</strong>).</li>\n</ul>\n<p> </p>\n<p><strong>Lifestyle Modifications:</strong></p>\n<ul>\n<li>Avoid alcohol, nicotine, and caffeine.</li>\n<li>Maintain a regular sleep pattern.</li>\n<li>Engage in moderate exercise.</li>\n<li>Use leg massage, warm baths, heating pads, or foot wraps for relief.</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following culture media is used to differentiate E. coli O157:H7 from other E. coli species?", "options": [{"label": "A", "text": "Mannitol salt agar", "correct": false}, {"label": "B", "text": "Xylose lysine deoxycholate (XLD) agar", "correct": false}, {"label": "C", "text": "Sorbitol MacConkey (SMAC) agar", "correct": true}, {"label": "D", "text": "CLED medium", "correct": false}], "correct_answer": "C. Sorbitol MacConkey (SMAC) agar", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/F5YKsSg4pJAYG08pRtpY1745227628.png", "https://image.prepladder.com/content/Z0ij4CnctTbRgmNH1FwZ1745227628.png", "https://image.prepladder.com/content/uVdRR6qX2fwNq3zhx6mK1745227628.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Result</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Indole Production</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>E. <span class=\"customMeta\" data-dictid=\"cd0a7121a516927771846d8f5248bb\">coli</span> is typically <span class=\"customMeta\" data-dictid=\"bc8d0dbfcf169277719012cdb493a1\">indole</span> positive.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Methyl Red (MR) Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>E. <span class=\"customMeta\" data-dictid=\"cd0a7121a516927771846d8f5248bb\">coli</span> shows a positive result.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Voges-Proskauer (VP) Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>E. <span class=\"customMeta\" data-dictid=\"cd0a7121a516927771846d8f5248bb\">coli</span> is typically negative.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Citrate Utilization</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>E. <span class=\"customMeta\" data-dictid=\"cd0a7121a516927771846d8f5248bb\">coli</span> usually does not utilize <span class=\"customMeta\" data-dictid=\"3569209ba41692777184f88db9316d\">citrate</span> (negative result).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Triple Sugar Iron (TSI) Agar</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Shows <span class=\"customMeta\" data-dictid=\"cc108d77f11692777202478d5c72bf\">fermentation</span> of glucose, lactose, and production of gas.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Urease Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>E. <span class=\"customMeta\" data-dictid=\"cd0a7121a516927771846d8f5248bb\">coli</span> is <span class=\"customMeta\" data-dictid=\"f9076f5a1d1692777201e6af082c74\">urease</span> negative.</p>\n</td>\n</tr>\n</tbody>\n\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:center\">\n<p><strong>Member</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:center\">\n<p><strong>Motility</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:center\">\n<p><strong>Lactose fermenting/ Non-lactose fermenting</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:center\">\n<p><strong>IMViC</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:center\">\n<p><strong>Urease</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>E. coli</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>Motile</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>Lactose fermenting</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>++--</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>Negative</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>Klebsiella</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>Non-motile</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>Lactose fermenting</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>--++</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>Positive</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>Enterobacter</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>Motile</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>Lactose fermenting</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>--++</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>Negative</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>Citrobacter</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>Motile.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>Lactose fermenting</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>V</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>Negative</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>Shigella</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>Non-motile</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>Non-lactose fermenting</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>-+--</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>Negative</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>Salmonella*</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>Motile</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>Non-lactose fermenting</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>-+-+</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>Negative</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>Proteus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>Motile</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>Non-lactose fermenting</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>V</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>Positive</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>Yersinia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>Motile/Non-motile</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>Non-lactose fermenting</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>-+--</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:none; border-right:1px solid #000000; border-top:none; vertical-align:center\">\n<p>Negative</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable diagnosis for a first-year MBBS student who presents at the OPD with intermittent episodes of intense sweating and a sensation of imminent danger, commonly experienced before her examinations?", "options": [{"label": "A", "text": "Panic disorder", "correct": true}, {"label": "B", "text": "Conversion disorder", "correct": false}, {"label": "C", "text": "Social anxiety disorder", "correct": false}, {"label": "D", "text": "Generalized anxiety disorder", "correct": false}], "correct_answer": "A. Panic disorder", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - Panic disorder:</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Panic disorder</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>General information</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>More common in females than males.</li>\n<li>Median age of onset: late <span class=\"customMeta\" data-dictid=\"98d9739e5f1692777180d7de404750\">adolescence</span> or early adulthood.</li>\n<li>Familial risk: Highest for early-onset panic disorder.</li>\n<li>Patients with panic disorder commonly have agoraphobia</li>\n<li>Panic attacks for more than a month are termed as a Panic disorder.</li>\n<li>Neurotransmitters that are implicated in the development of panic disorders are norepinephrine, Serotonin, GABA, and Cholecystokinin.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Unexpected onset, not tied to specific situations.</li>\n<li>Duration typically 20–30 minutes, rarely exceeding one hour.</li>\n<li><strong>Cardiopulmonary symptoms:</strong> Shortness of breath, palpitations, chest discomfort.</li>\n<li><strong>Gastrointestinal symptoms:</strong> Nausea, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> discomfort.</li>\n<li><strong>Neurological symptoms:</strong> Tremors, dizziness, numbness, <span class=\"customMeta\" data-dictid=\"b7020a23961692777200b1237ae429\">tingling</span> sensations.</li>\n<li><strong>Psychiatric symptoms:</strong> Derealization, depersonalization, fear of losing control, fear of dying.</li>\n<li><strong>Other symptoms:</strong> Sweating, chills or hot flashes, flushed sensations</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pharmacotherapy:</strong></p>\n<ul>\n<li><strong>Drug of choice</strong>: Selective <span class=\"customMeta\" data-dictid=\"06eba971ce169277719884f8c62937\">serotonin</span> <span class=\"customMeta\" data-dictid=\"42c441fad11692777197258f322307\">reuptake</span> inhibitors.<strong> </strong></li>\n<li>Other first-line: Serotonin-norepinephrine <span class=\"customMeta\" data-dictid=\"42c441fad11692777197258f322307\">reuptake</span> <span class=\"customMeta\" data-dictid=\"b5fb56a28b1692777190396ae8b625\">inhibitor</span> (SNRI) venlafaxine</li>\n<li>Second-line: <span class=\"customMeta\" data-dictid=\"66bf14385516927772001b3646b855\">Tricyclic</span> antidepressants, MAOIs, Other Psychotropics - Agomelatine, Buspirone, Mirtazapine.<strong> </strong></li>\n<li>Benzodiazepines: Short-term use as an <span class=\"customMeta\" data-dictid=\"e405fcd2f2169277718034536f004a\">adjunct</span> to SSRIs.</li>\n<li><strong>Acute phase</strong> – Benzodiazepines such as <span class=\"customMeta\" data-dictid=\"4398b2978c16927771915937fed503\">Lorazepam</span> &amp; Clonazepam.</li>\n</ul>\n<p><strong>Psychosocial therapies:</strong></p>\n<ul>\n<li>Cognitive-behavioral therapy (CBT)</li>\n<li>Interpersonal therapy.</li>\n</ul>\n<p><strong>Note:</strong> Treatment of choice: <strong>SSRIs + <span class=\"customMeta\" data-dictid=\"f3f884992516927771965b324c2faf\">Psychotherapy</span> (CBT)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Ligation of common hepatic artery will impair blood supply in:", "options": [{"label": "A", "text": "Right gastric and right gastroepiploic artery", "correct": true}, {"label": "B", "text": "Right gastric and left gastric artery", "correct": false}, {"label": "C", "text": "Right gastroepiploic and short gastric vessels", "correct": false}, {"label": "D", "text": "Right gastric and short gastric vessels", "correct": false}], "correct_answer": "A. Right gastric and right gastroepiploic artery", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/MjgiZkRwXPy4GhYXClqL1745227921.png"], "explanation": "<p>Correct Option A) Right &lt;span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\"&gt;gastric&lt;/span&gt; and right &lt;span class=\"customMeta\" data-dictid=\"4a2f01d90816927771883e2bc0844f\"&gt;gastroepiploic&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What diagnosis, according to DSM-,V would be appropriate for a middle-aged female patient who has been experiencing symptoms such as loss of interest in daily activities, weight loss, insomnia, and persistent sadness for a period of six months? Additionally, she reports a single incident of hearing a voice instructing her to commit suicide.", "options": [{"label": "A", "text": "Major depressive disorder with psychotic features", "correct": true}, {"label": "B", "text": "Schizophrenia", "correct": false}, {"label": "C", "text": "Schizoaffective disorder", "correct": false}, {"label": "D", "text": "Delusional disorder", "correct": false}], "correct_answer": "A. Major depressive disorder with psychotic features", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - Major depressive disorder with &lt;span class=\"customMeta\" data-dictid=\"23702653681692777196e5c0fc63cd\"&gt;psychotic&lt;/span&gt; features</p>\n<table align=\"left\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Psychotic depression</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Major depression disorder (MDD) with <span class=\"customMeta\" data-dictid=\"23702653681692777196e5c0fc63cd\">psychotic</span> features includes mood <span class=\"customMeta\" data-dictid=\"4586eccbe71692777186e577e31829\">disturbance</span> with delusions, hallucinations, or both.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prevalence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It occurs in approximately 18.5% of MDD patients and increases with age.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Higher treatment resistance</li>\n<li>More suicide attempts</li>\n<li>Longer illness duration</li>\n<li>Greater functional impairment</li>\n<li>Higher <span class=\"customMeta\" data-dictid=\"b4b361c37616927771979541177070\">relapse</span> rates</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Older patients may exhibit more brain <span class=\"customMeta\" data-dictid=\"97ff5253fb169277718224c7b0faf8\">atrophy</span> and higher mortality rates compared to non-psychotic patients.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Geriatric Considerations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Patients often show significant cognitive dysfunction; <span class=\"customMeta\" data-dictid=\"f6e39eb41116927771865b34e2ec08\">depressive pseudodementia</span> may develop.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cognitive Impairment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Combination therapy</strong>: <strong>antidepressants </strong>+ <strong>antipsychotics </strong>or <strong>ECT </strong>is the standard of care.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment Approaches</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Monotherapy </strong>with <strong>SSRIs </strong>or <strong>TCAs </strong>is <strong>less effective</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Efficacy of ECT</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>ECT shows high <span class=\"customMeta\" data-dictid=\"b4a3b8da7716927771975375dadad9\">remission</span> rates (up to 95% in <span class=\"customMeta\" data-dictid=\"23702653681692777196e5c0fc63cd\">psychotic</span> depression) compared to pharmacotherapy.</li>\n<li><strong>ECT is first-line treatment in case of severe <span class=\"customMeta\" data-dictid=\"23702653681692777196e5c0fc63cd\">psychotic</span> symptoms and high suicide risk.</strong></li>\n</ul>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the appropriate course of action for a 24-year-old woman with a complete perineal tear after vaginal delivery?", "options": [{"label": "A", "text": "Repair immediately", "correct": true}, {"label": "B", "text": "Repair after 3 weeks", "correct": false}, {"label": "C", "text": "Repair after 6 months", "correct": false}, {"label": "D", "text": "Repair after 3 months", "correct": false}], "correct_answer": "A. Repair immediately", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/YFIh01PC99M0rk9L5Pqx1746445249.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Degree of Tear</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1st-degree tear</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Superficial tear of the <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> mucosa</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Usually heals spontaneously; may not require intervention</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2nd-degree tear</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involves <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> and <span class=\"customMeta\" data-dictid=\"befda305051692777195a95ee0695a\">perineal</span> muscles</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Repairs with sutures, typically performed soon after delivery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3rd-degree tear</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Extends to the anal sphincter</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Repairs with sutures, performed soon after delivery or within 24 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>4th-degree tear</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involves anal <span class=\"customMeta\" data-dictid=\"1a73a42f071692777199a59120f494\">sphincter</span> and rectal mucosa</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Repairs with sutures, usually requires <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> intervention; performed soon after delivery or within 24 hours</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is correct regarding a woman receiving radiotherapy for endometrial carcinoma?", "options": [{"label": "A", "text": "Intensity is inversely proportional to squared distance", "correct": true}, {"label": "B", "text": "Small blood vessels are the most radioresistant", "correct": false}, {"label": "C", "text": "Rapidly proliferating cells are the most radioresistant", "correct": false}, {"label": "D", "text": "Small bowel is the most radioresistant", "correct": false}], "correct_answer": "A. Intensity is inversely proportional to squared distance", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the maternal condition that can cause the observed findings in the baby as presented below?", "options": [{"label": "A", "text": "Pre-gestational diabetes", "correct": true}, {"label": "B", "text": "Gestational diabetes mellitus", "correct": false}, {"label": "C", "text": "Effect of valproate", "correct": false}, {"label": "D", "text": "Hypertensive of ACE inhibitors", "correct": false}], "correct_answer": "A. Pre-gestational diabetes", "question_images": ["https://image.prepladder.com/content/my921bIquPkRoXxxHHWS1745229940.png"], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the drug of choice for invasive pulmonary aspergillosis?", "options": [{"label": "A", "text": "Itraconazole", "correct": false}, {"label": "B", "text": "Voriconazole", "correct": true}, {"label": "C", "text": "Lyophilized Amphotericin B", "correct": false}, {"label": "D", "text": "Posaconazole", "correct": false}], "correct_answer": "B. Voriconazole", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/ze14hvFwtwUxCdH3SgFn1746447031.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A woman, who is currently 38 weeks pregnant, visits the outpatient department for a regular checkup. She had previously given birth to healthy twins at full term, 4 years ago. What is her obstetric score?", "options": [{"label": "A", "text": "G2P2", "correct": false}, {"label": "B", "text": "G2P1", "correct": true}, {"label": "C", "text": "G3P2", "correct": false}, {"label": "D", "text": "G3P1", "correct": false}], "correct_answer": "B. G2P1", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old patient presents with chronic watery diarrhea. The histopathology of the duodenum is shown in the image. What is the causative organism?", "options": [{"label": "A", "text": "Giardia lamblia", "correct": true}, {"label": "B", "text": "Entamoeba histolytica", "correct": false}, {"label": "C", "text": "Microsporidia", "correct": false}, {"label": "D", "text": "Cryptosporidia", "correct": false}], "correct_answer": "A. Giardia lamblia", "question_images": ["https://image.prepladder.com/notes/WJYzXEXZvIL1XQdUlWzc1746447222.png"], "explanation_images": ["https://image.prepladder.com/content/wHp4rJRNiutFWiu0nW5f1745230305.png", "https://image.prepladder.com/content/1ygxEcnJX4VYdluDF19o1745230305.png", "https://image.prepladder.com/content/faeITlnIsX6asQEuMi8m1745230305.png", "https://image.prepladder.com/notes/dLLkjHFIz6K6z8YGJzNf1746447791.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not involved in urethritis?", "options": [{"label": "A", "text": "Trichomonas", "correct": false}, {"label": "B", "text": "Chlamydia", "correct": false}, {"label": "C", "text": "Neisseria gonorrhoeae", "correct": false}, {"label": "D", "text": "Haemophilus ducreyi", "correct": true}], "correct_answer": "D. Haemophilus ducreyi", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/4HdY9AOnmLajkaBqu1u21746448035.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:643px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Factor V</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Factor X</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>CO2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Hemolysis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>H. influenzae</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>H. aegypticus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>H. ducreyi</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>H. Parainflenzae</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>H. hemolyticus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>H. parahaemolyticus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>H. aphrophilus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>H. paraphrophilus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A woman with a history of infertility is on treatment with human menopausal gonadotropin. She presented with the following findings in the given USG. What is the diagnosis?", "options": [{"label": "A", "text": "Ovarian hyperstimulation syndrome", "correct": true}, {"label": "B", "text": "Theca lutein cyst", "correct": false}, {"label": "C", "text": "Polycystic ovarian syndrome", "correct": false}, {"label": "D", "text": "None", "correct": false}], "correct_answer": "A. Ovarian hyperstimulation syndrome", "question_images": ["https://image.prepladder.com/notes/iapeggij6u9qpxZc2s3k1746445405.png"], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mild OHSS</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Abdominal bloating</li>\n<li>Mild <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain</li>\n<li>Ovarian size usually &lt;8 cm</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Moderate OHSS</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Moderate <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain</li>\n<li>Nausea ± vomiting</li>\n<li>Ultrasound evidence of ascites</li>\n<li>Ovarian size usually 8-12 cm</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Clinical <span class=\"customMeta\" data-dictid=\"a1146fb9d8169277718250cf1224a8\">ascites</span> (± hydrothorax)</li>\n<li>Oliguria (&lt;300 ml/day or &lt;30 ml/h)</li>\n<li>Hematocrit &gt;0.45- Hyponatremia (sodium &lt;135 mmol/l)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hypo-osmolality (osmolality &lt;282 mOsm/kg)</li>\n<li>Hypoproteinemia (serum <span class=\"customMeta\" data-dictid=\"1fa594dc2b169277718104d76aa4e2\">albumin</span> &lt;35 g/l)</li>\n<li>Ovarian size usually &gt;12 cm</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Critical OHSS</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Tense ascites/large hydrothorax</li>\n<li>Hematocrit &gt;0.55- White cell count &gt;25000/ml</li>\n<li>Oliguria/anuria</li>\n<li>Thromboembolism</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Acute <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"afafb9026e1692777186e3dd168fa8\">distress</span> syndrome</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not true about Japanese encephalitis (JE)?", "options": [{"label": "A", "text": "Transmitted by Culex vishnui", "correct": false}, {"label": "B", "text": "Pig is the amplifier host", "correct": false}, {"label": "C", "text": "Man acts as the reservoir", "correct": true}, {"label": "D", "text": "Human is a dead-end host", "correct": false}], "correct_answer": "C. Man acts as the reservoir", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/gCjkzKfDBRU28jqgKyMz1746448207.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:612px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Epidemiological features of Japanese encephalitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Agent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Japanese <span class=\"customMeta\" data-dictid=\"9644652a1f16927771873765457fcc\">Encephalitis</span> Virus (JEV), Group B Arbovirus</p>\n<p>Virus Family: Flaviviridae</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Transmission Vector</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Culex mosquitoes </strong>(Culex tritaeniorhynchus and <span class=\"customMeta\" data-dictid=\"8821feceff1692777185b2fc88c7dd\">Culex</span> vishnui) <strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hosts</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pigs (Amplifier Host) (Option B ruled out)</strong></p>\n<p>Ardeid Birds: Pond herons, Ducks, Poultry (Maintenance Host)</p>\n<p><strong>Man: (Accidental or dead-end host)</strong></p>\n<ul>\n<li>Do not develop high enough <span class=\"customMeta\" data-dictid=\"449328a76c1692777202f8f9fd20b8\">viremia</span> to <span class=\"customMeta\" data-dictid=\"eb32e458601692777190ed974ab329\">infect</span> mosquitoes.</li>\n<li>Primarily children (below 15 years), but all ages susceptible</li>\n<li>No man-to-man transmission.</li>\n</ul>\n<p><strong>Horses</strong>: Only animals that can manifest symptoms.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Environmental Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Geographic Distribution:</strong></p>\n<ul>\n<li>Southeast Asia, East Asia, and the Western Pacific regions.</li>\n<li>India\n\t\t\t\t<ul>\n<li>Endemic: To 21 states but mainly includes Jharkhand, Bihar, West Bengal, Uttar Pradesh, Assam and Haryana</li>\n</ul>\n</li>\n<li>Seasonal Distribution:\n\t\t\t\t<ul>\n<li>Monsoon and post-monsoon period (varies by region)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements about radiotherapy in a 52-year-old woman diagnosed with stage 2B carcinoma cervix is incorrect?", "options": [{"label": "A", "text": "Point B is 3 cm lateral to point A", "correct": false}, {"label": "B", "text": "Point A is 2 cm above the external os and 5cm lateral to the internal uterine canal", "correct": true}, {"label": "C", "text": "Point A receives a dose of 7000 cGy", "correct": false}, {"label": "D", "text": "Point B receives a dose of 6000 cGy", "correct": false}], "correct_answer": "B. Point A is 2 cm above the external os and 5cm lateral to the internal uterine canal", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/YIQx4DIA1nVG5m4oPn7n1746445522.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the predominant pathogen to infect renal transplant recipients in the period around 1 to 4 months following transplantation?", "options": [{"label": "A", "text": "Cytomegalovirus", "correct": true}, {"label": "B", "text": "JC virus", "correct": false}, {"label": "C", "text": "BK virus", "correct": false}, {"label": "D", "text": "Epstein-Barr virus", "correct": false}], "correct_answer": "A. Cytomegalovirus", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old HIV-positive patient presents with mucosal lesions in the mouth. On microscopy, budding yeasts and pseudohyphae are observed. What is the likely diagnosis?", "options": [{"label": "A", "text": "Oral candidiasis", "correct": true}, {"label": "B", "text": "Hairy leukoplakia", "correct": false}, {"label": "C", "text": "Lichen planus", "correct": false}, {"label": "D", "text": "Diphtheria", "correct": false}], "correct_answer": "A. Oral candidiasis", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/Xt6rCRnOZCmlZcbMlDDv1746448376.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:724px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Oral candidiasis</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Oral candidiasis, commonly known as <strong>thrush</strong>, is an infection caused by an <span class=\"customMeta\" data-dictid=\"2840cd55771692777194448139206d\">overgrowth</span> of Candida albicans, a type of yeast.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Presentation </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Presence of white patches that can be scraped off leaving behind a red inflamed base</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"MI605\" data-author=\"CDC\" data-hash=\"12027\" data-license=\"OPEN ACCESS\" data-source=\"https://commons.wikimedia.org/wiki/File:Oral_thrush_Aphthae_Candida_albicans._PHIL_1217_lores.jpg\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/Xt6rCRnOZCmlZcbMlDDv1746448376.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk factors </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Diabetes</strong>: Poorly controlled diabetes creates a favorable environment for Candida growth due to elevated <span class=\"customMeta\" data-dictid=\"88b48cf7241692777183e5f5b8adf1\">blood sugar</span> levels.</li>\n<li><strong>Neutropenia</strong></li>\n<li><strong>Immunosuppression</strong>: HIV/AIDS, cancer, or <span class=\"customMeta\" data-dictid=\"c3c986cd721692777189b473814b2e\">immunosuppressive</span> medications increases susceptibility.</li>\n<li><strong>Use of inhaled corticosteroids </strong></li>\n<li><strong>Antibiotic Use</strong>: Broad-spectrum antibiotics can disrupt normal oral flora, allowing Candida to overgrow.</li>\n<li><strong>Poor Oral Hygiene</strong>: Lead to an increase in fungal colonization.</li>\n<li><strong>Dry Mouth</strong>: Conditions that lead to <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"6b0184a84d16927771981289924c2a\">saliva</span> production can promote candidiasis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Antifungal medications, such as <span class=\"customMeta\" data-dictid=\"4fb71710a61692777193d5ad608167\">nystatin</span> or fluconazole, along with addressing any underlying risk factors.</p>\n<p>C. krusei- Resistant to azoles</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:645px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Oral Candidiasis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Hairy Leukoplakia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Lichen Planus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Diphtheria</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Candida albicans</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Epstein-Barr Virus (EBV)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Autoimmune</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Corynebacterium diphtheriae</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>White, curd-like plaques</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>White, corrugated plaques</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reticular white striae</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Grayish pseudomembrane</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Scrapable</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Yes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No (bleeds on removal)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Microscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Budding yeasts, pseudohyphae</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No fungal elements</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No fungal elements</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gram-positive rods</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Seen in HIV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Yes, common in immunocompromised</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Yes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rare</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient is planned to undergo hysteroscopic polypectomy using bipolar electrocautery. What is the ideal agent for distention?", "options": [{"label": "A", "text": "Glycine", "correct": false}, {"label": "B", "text": "Normal saline", "correct": true}, {"label": "C", "text": "CO 2", "correct": false}, {"label": "D", "text": "70% dextrose", "correct": false}], "correct_answer": "B. Normal saline", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Medium</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Properties</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Indications</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gas (Carbon Dioxide)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Colorless gas</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diagnostic, <span class=\"customMeta\" data-dictid=\"f79470fd4a16927771940b525da4db\">Operative</span> with <span class=\"customMeta\" data-dictid=\"df4ae006fe1692777183604169e9b2\">bipolar</span> tools</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Electrolyte Fluid (0.9% saline)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Isotonic, 380 mOsm/kg H<sub>2</sub>O</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diagnostic, <span class=\"customMeta\" data-dictid=\"f79470fd4a16927771940b525da4db\">Operative</span> with <span class=\"customMeta\" data-dictid=\"df4ae006fe1692777183604169e9b2\">bipolar</span> tools</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lactated Ringer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Isotonic, 273 mOsm/kg H<sub>2</sub>O</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diagnostic, <span class=\"customMeta\" data-dictid=\"f79470fd4a16927771940b525da4db\">Operative</span> with <span class=\"customMeta\" data-dictid=\"df4ae006fe1692777183604169e9b2\">bipolar</span> tools</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Electrolyte-poor fluid (Sorbitol 3%)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypoosmolar, 178 mOsm/kg H<sub>2</sub>O</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Operative with <span class=\"customMeta\" data-dictid=\"791dbee3ff1692777192bf25e5fbd1\">monopolar</span> tools</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mannitol 5%</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Isosmolar, 280 mOsm/kg H<sub>2</sub>O</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Operative with <span class=\"customMeta\" data-dictid=\"791dbee3ff1692777192bf25e5fbd1\">monopolar</span> tools</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Glycine 1.5%</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypoosmolar, 200 mOsm/kg H<sub>2</sub>O</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Operative with <span class=\"customMeta\" data-dictid=\"791dbee3ff1692777192bf25e5fbd1\">monopolar</span> tools</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In which trimester does acute fatty liver manifest most commonly during pregnancy?", "options": [{"label": "A", "text": "First trimester", "correct": false}, {"label": "B", "text": "Second trimester", "correct": false}, {"label": "C", "text": "Third trimester", "correct": true}, {"label": "D", "text": "Both (a) and (b)", "correct": false}], "correct_answer": "C. Third trimester", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>A rare, life-threatening liver disorder that occurs in the <strong>third <span class=\"customMeta\" data-dictid=\"2c20f0f1dd169277720029d29458d5\">trimester</span> of pregnancy</strong>, characterised by microvesicular <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> <span class=\"customMeta\" data-dictid=\"669bdcb3111692777190e018ae930e\">infiltration</span> of hepatocytes.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>First pregnancy</li>\n<li>Multiple gestations</li>\n<li>Male fetus</li>\n<li>Pre-eclampsia</li>\n<li>Maternal obesity</li>\n<li>Prior history of AFLP</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Nausea and vomiting</li>\n<li>Right upper <span class=\"customMeta\" data-dictid=\"3a757d7c1216927771968223be411d\">quadrant</span> pain</li>\n<li>Jaundice</li>\n<li>Malaise and fatigue</li>\n<li>Anorexia</li>\n<li>Polydipsia and polyuria</li>\n<li>Ascites (rare)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigation </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Elevated AST, ALT</li>\n<li>Elevated bilirubin</li>\n<li>Hypofibrinogenemia</li>\n<li>Prolonged <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> time</li>\n<li>High D-dimer</li>\n<li>Hypocholesterolemia</li>\n<li>Microscopy: Microvesicular <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> infiltration</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Liver failure</li>\n<li>Renal failure</li>\n<li>Coagulopathy</li>\n<li>Hypoglycemia</li>\n<li>Encephalopathy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Immediate delivery of the baby (definitive treatment)</li>\n<li>Supportive care for the mother: IV fluids, <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> infusion, and blood products for coagulopathy.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The test kit shown in the image below works on which principle?", "options": [{"label": "A", "text": "ELISA", "correct": false}, {"label": "B", "text": "Immunochromatography", "correct": true}, {"label": "C", "text": "Immunofluorescence", "correct": false}, {"label": "D", "text": "Chemiluminescence", "correct": false}], "correct_answer": "B. Immunochromatography", "question_images": ["https://image.prepladder.com/notes/zq0shzoJxv8rNhTazM7m1746448540.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type of Detection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Sensitivity (%) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Specificity (%) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Note</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Hepatitis B Virus (HBV)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Antibodies (anti-HBs) or antigens (HBsAg)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt; 95</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt; 99</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reliable for initial screening</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Hepatitis C Virus (HCV)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Antibodies against HCV</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>90 - 98</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>95 - 100</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Critical for quick identification</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>COVID-19</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>IgM and IgG antibodies</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>98.68 (IgM), 98.72 (IgG)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>93.10 (IgM), 100 (IgG)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Effective for serological diagnosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rapid <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> tests</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>94.3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>100</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Effective for early diagnosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Malaria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Specific antigens from <span class=\"customMeta\" data-dictid=\"8b4c650ddd1692777191286afbcd8a\">malaria</span> parasites</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>90 - 95</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>~95</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Timely treatment decisions are critical</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the investigation and the lesion depicted in the image given below:", "options": [{"label": "A", "text": "Retrograde cystourethrogram with membranous urethra stricture", "correct": false}, {"label": "B", "text": "Retrograde cystourethrogram with penile urethral stricture", "correct": true}, {"label": "C", "text": "Micturating cystourethrography with bulbar stricture", "correct": false}, {"label": "D", "text": "Micturating cystourethrography with prostatic urethra stricture", "correct": false}], "correct_answer": "B. Retrograde cystourethrogram with penile urethral stricture", "question_images": ["https://image.prepladder.com/notes/GviO7vOb60TnhQvULcWK1746431354.png"], "explanation_images": ["https://image.prepladder.com/notes/kWnUqdaWhhttIUEFqzsI1746431490.png", "https://image.prepladder.com/notes/z4MOC6LYUzvUXX7l688z1746431579.png", "https://image.prepladder.com/notes/TpUEYCyOtLmTHpCNvTOG1746431821.png"], "explanation": "<p>Correct Answer B - Retrograde &lt;span class=\"customMeta\" data-dictid=\"7d3833cfbf1692777185c44c246cf4\"&gt;cystourethrogram&lt;/span&gt; with penile urethral stricture</p>\n<table align=\"left\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Urethral Stricture</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Abnormal narrowing of the <span class=\"customMeta\" data-dictid=\"a594ff734f16927772016f656d39eb\">urethra</span> causes partial or complete <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> of <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> flow, leading to discomfort and severe complications if untreated.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Trauma (Most common): </strong>Pelvic fractures, falls, accidents, or <span class=\"customMeta\" data-dictid=\"36ddb6e17916927771892e93a27c53\">iatrogenic</span> trauma from prolonged catheterization.</p>\n<p><strong>Infections: </strong>STIs like gonorrhoea and <span class=\"customMeta\" data-dictid=\"21e09b6e771692777184f66df5bf7a\">chlamydia</span> cause urethritis.</p>\n<p><strong>Medical Procedures</strong>: Urethral surgeries or radiation for <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> cancers.</p>\n<p><strong>Inflammatory Conditions:</strong> Chronic <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> from conditions like <span class=\"customMeta\" data-dictid=\"d176adf87f1692777191722064a021\">lichen</span> sclerosus.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Posterior Urethral Stricture:</strong> <strong>Micturating <span class=\"customMeta\" data-dictid=\"7d3833cfbf1692777185c44c246cf4\">Cystourethrogram</span> (MCU)</strong> to <span class=\"customMeta\" data-dictid=\"67407c787d1692777202245c791c31\">visualize</span> the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"a594ff734f16927772016f656d39eb\">urethra</span> and <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> during voiding. <strong>(Option C &amp; D ruled out)</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"PSU099\" data-author=\"Pal, Partha &amp; Ray, Sayantan &amp; Talukdar, Arunansu &amp; Sonthalia, Nikhil &amp; Chakraborty, Sumit.\" data-hash=\"11765\" data-license=\"CC BY NC ND 4.0\" data-source=\"https://www.researchgate.net/figure/A-Retrograde-urethrogram-demonstrating-a-narrowing-in-the-proximal-bulbar-urethra-B_fig2_262531126\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/kWnUqdaWhhttIUEFqzsI1746431490.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>Anterior Urethral Stricture:</strong> <strong>Retrograde Urethrogram (RGU).</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"PSU100\" data-author=\"NA\" data-hash=\"11769\" data-license=\"NA\" data-source=\"https://www.keshavamhospital.com/stricture-urethra.php\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/z4MOC6LYUzvUXX7l688z1746431579.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>Emergency Evaluation: </strong>Both RGU and MCU may be used in trauma cases or <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> retention.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Urethral Dilation:</strong> Temporary relief with dilators, often leading to recurrence.</p>\n<p><strong>Optical Internal Urethrotomy (OIU):</strong> Endoscopic <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> at the 12 o'clock position; effective for short <span class=\"customMeta\" data-dictid=\"ef00544aba1692777183bc916b1c30\">bulbar</span> strictures (&lt;2 cm).</p>\n<p><strong>Urethroplasty:</strong> Surgical <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> and reconstruction; the gold standard for <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> or complex strictures</p>\n<ul>\n<li><strong>Strictures up to 2 cm:</strong> <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">Excision</span> with end-to-end anastomosis.</li>\n<li><strong>Strictures &gt;2 cm:</strong> <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">Excision</span> and <span class=\"customMeta\" data-dictid=\"b29f3bf7cd1692777197ee03d829e9\">reconstruction</span> with <span class=\"customMeta\" data-dictid=\"d72626dd5c1692777183f1c92b2deb\">buccal</span> mucosa, <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> mucosa, or penile skin.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following causative agents is commonly transmitted by soil and is characterized by the egg in stool, as shown in the image below?", "options": [{"label": "A", "text": "Trichuris trichiura", "correct": true}, {"label": "B", "text": "Ancylostoma duodenale", "correct": false}, {"label": "C", "text": "Necator americanus", "correct": false}, {"label": "D", "text": "Ascaris lumbricoides", "correct": false}], "correct_answer": "A. Trichuris trichiura", "question_images": ["https://image.prepladder.com/content/dxKBsxLQVxdl1LoncbZQ1745231208.png"], "explanation_images": ["https://image.prepladder.com/content/0Di8KbRrpuNscXgFQoTT1745231252.png", "https://image.prepladder.com/content/kLaog9EXKGPHZYyaNICt1745231252.png", "https://image.prepladder.com/notes/xeQ3DD8F9HxGHnWBjmPO1746448935.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:716px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Morphology</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p><strong>Adult worm</strong></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"276\" src=\"https://image.prepladder.com/content/0Di8KbRrpuNscXgFQoTT1745231252.png\" width=\"447\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The male <span class=\"customMeta\" data-dictid=\"cc08235a711692777202fabc5d7cdb\">worm</span> is 30-45 mm long.</li>\n<li>The female <span class=\"customMeta\" data-dictid=\"cc08235a711692777202fabc5d7cdb\">worm</span> is 40-50 mm long (slightly larger).</li>\n<li>Appearance:\n\t\t\t\t<ul>\n<li>Flesh-colored.</li>\n<li>Whip-shaped: <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> (3/5) thin and thread-like; <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> (2/5) thick and <span class=\"customMeta\" data-dictid=\"384d0cc3641692777202e927a4d222\">fleshy</span> (like a handle).</li>\n<li>The end of the male worms is coiled ventrally.</li>\n<li>The end of the female <span class=\"customMeta\" data-dictid=\"cc08235a711692777202fabc5d7cdb\">worm</span> is straight, blunt, and rounded.</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li>Body structure:\n\t\t\t\t<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> portion contains a <span class=\"customMeta\" data-dictid=\"89e3252d5b16927771833fb9b432ae\">capillary</span> esophagus.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> part contains the intestines and <span class=\"customMeta\" data-dictid=\"11e24b369816927771974383c7e17c\">reproductive</span> organs.</li>\n</ul>\n</li>\n<li>Lifespan: 5-10 years.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Eggs </strong></p>\n<p> </p>\n<p> </p>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"CDC Division of Parasitic Diseases\" data-hash=\"\" data-license=\"Open access\" data-source=\"https://www.cdc.gov/dpdx/trichuriasis/index.html\" data-tags=\"\" height=\"459\" src=\"https://image.prepladder.com/content/kLaog9EXKGPHZYyaNICt1745231252.png\" width=\"459\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Characteristics:</strong></p>\n<ul>\n<li>The eggs appear <strong>brown </strong>as they are bile-stained.</li>\n<li>They are <strong>barrel-shaped</strong>.</li>\n<li>They have a triple shell with a brown outer layer and a colorless <strong>mucus <span class=\"customMeta\" data-dictid=\"7803d1e7ea169277719552dc5e49d4\">plug</span> </strong>at each pole containing an unsegmented ovum.</li>\n</ul>\n<p><strong>Infectivity:</strong></p>\n<ul>\n<li>Freshly passed eggs contain an <strong>unsegmented ovum</strong> and are <strong>not infective</strong> for humans.</li>\n<li>The egg <strong>floats in a <span class=\"customMeta\" data-dictid=\"bd2ac838bb16927771983dd9afc74c\">saturated</span> salt solution.</strong></li>\n<li>The fertilized female lays about 5,000 eggs per day.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p> </p>\n<p><strong>Epidemiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Distribution:\n\t\t\t\t<ul>\n<li>Worldwide, with higher <span class=\"customMeta\" data-dictid=\"f86aae0bd61692777196f91458c9dd\">prevalence</span> in tropical regions.</li>\n<li>Common in tropical Africa, South America, and Southeast Asia.</li>\n<li>Widespread in India.</li>\n</ul>\n</li>\n<li>Prevalence:\n\t\t\t\t<ul>\n<li>An estimated 800 million people are infected globally.</li>\n<li>While <span class=\"customMeta\" data-dictid=\"170c045a511692777202cdca12aae0\">whipworm</span> infections are frequent, <span class=\"customMeta\" data-dictid=\"170c045a511692777202cdca12aae0\">whipworm</span> disease is relatively rare.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old woman who is pregnant with twins conceived through in vitro fertilization. She is a first-time mother and has reached 38 weeks of gestation. During an antenatal checkup, it was discovered that the first twin is in a breech position, and the mother's blood pressure has been consistently higher than 140/90 mm Hg on two occasions, accompanied by grade 1+ proteinuria. What further actions should be taken?", "options": [{"label": "A", "text": "Monitor BP and terminate pregnancy if BP rises", "correct": false}, {"label": "B", "text": "Immediate caesarean section", "correct": true}, {"label": "C", "text": "Terminate pregnancy at 40 weeks of gestation", "correct": false}, {"label": "D", "text": "Induce labour with PGE2 gel", "correct": false}], "correct_answer": "B. Immediate caesarean section", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 14-year-old boy presents with a history of vomiting within 3 hours of consuming food at a party. Which of the following organisms is most likely responsible?", "options": [{"label": "A", "text": "Staphylococcus aureus", "correct": true}, {"label": "B", "text": "Clostridium botulinum", "correct": false}, {"label": "C", "text": "Clostridium perfringens", "correct": false}, {"label": "D", "text": "Salmonella typhi", "correct": false}], "correct_answer": "A. Staphylococcus aureus", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:715px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Virulence factors</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Key features</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cell wall-associated polymers</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Peptidoglycan</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Activates complement-induced release of <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> cytokines</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Teichoic acid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Adherence to the host cell surface, and shields them from complement-mediated opsonization</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Capsular polysaccharide</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inhibits opsonization</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cell surface</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Protein A</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Anti-complementary</li>\n<li>Anti-phagocytic</li>\n<li>Co-agglutination</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clumping factor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Responsible for the slide <span class=\"customMeta\" data-dictid=\"f7fb4e31f916927771845b31e25215\">coagulase</span> test</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Toxins</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hemolysin </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Alpha hemolysin-</p>\n<ul>\n<li>Lyse sheep and human red blood cells.</li>\n<li>Toxic to macrophages, lysosomes, muscle tissues, the <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> cortex, and the <span class=\"customMeta\" data-dictid=\"f3739d892c1692777184b2e134615c\">circulatory</span> system</li>\n</ul>\n<p>Beta-hemolysins or sphingomyelinase</p>\n<ul>\n<li>Lyse sheep red blood cells only</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Panton-Valentine (PVL) Leucocidin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Synergohymenotropic toxin</li>\n<li>Attacks neutrophils, platelets</li>\n<li>Produced by Methicillin-Resistant Staph. aureus (MRSA)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Enterotoxin (superantigen)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Food poisoning</li>\n<li>Most cases are caused by type A.</li>\n<li>It acts directly on the <span class=\"customMeta\" data-dictid=\"bd1c98736616927771820954b0a744\">autonomic</span> nervous system causing symptoms. <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">Vomiting</span> is stimulated in the brain stem.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Toxic shock syndrome toxin(TSST) (superantigen)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Fatal multisystem disease</li>\n<li>Tampon-related TSS</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Epidermolytic/Exfoliative <span class=\"customMeta\" data-dictid=\"41329dc9381692777200a9b6d57cf4\">toxin</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Staphylococcal scalded skin syndrome (SSSS): the outer layer of the <span class=\"customMeta\" data-dictid=\"e4c62a77731692777187b9c7ded25d\">epidermis</span> gets separated from the underlying tissues.</li>\n<li>Severe <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of SSSS: Ritter's disease in the <span class=\"customMeta\" data-dictid=\"04df903fe8169277719383126b1b02\">newborn</span> and toxic <span class=\"customMeta\" data-dictid=\"616d85c57416927771875ef23f6751\">epidermal</span> <span class=\"customMeta\" data-dictid=\"254d4c2ea21692777193838ccf204d\">necrolysis</span> in older patients.</li>\n<li>Milder forms: <span class=\"customMeta\" data-dictid=\"73d23b64831692777195fed10389ac\">pemphigus</span> neonatorum and bullous impetigo</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Enzymes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Coagulase </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clotting of human or rabbit plasma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lipid hydrolases</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Helps in skin and <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> tissue infections</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hyaluronidase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Breaks down the <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissues</li>\n<li>Staphylokinase, protease</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Nuclease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Heat-stable DNase</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Causative Organism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Incubation Period</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Main Symptom</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Common Food Sources</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Staphylococcus aureus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1-5 hours</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Vomiting</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dairy, meats, eggs, bakery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Bacillus cereus (Emetic type)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1-5 hours</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Vomiting</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rice, pasta (reheated food)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clostridium perfringens</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>8-16 hours</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diarrhea/ Vomiting</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Meat dishes, stews</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clostridium botulinum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>12-36 hours</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Paralysis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Canned foods, honey (infants)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the definition of the Miami criteria regarding intraoperative parathyroid hormone (PTH) measurement among the options listed below?", "options": [{"label": "A", "text": "Quarter fall in 5 min", "correct": false}, {"label": "B", "text": "Quarter fall in 10 min", "correct": false}, {"label": "C", "text": "Half fall in 5 min", "correct": false}, {"label": "D", "text": "Half fall in 10 min", "correct": true}], "correct_answer": "D. Half fall in 10 min", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - H\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following organisms causes disease following traumatic inoculation into the skin?", "options": [{"label": "A", "text": "Sporothrix schenckii", "correct": true}, {"label": "B", "text": "Blastomyces dermatitidis", "correct": false}, {"label": "C", "text": "Coccidioides immitis", "correct": false}, {"label": "D", "text": "Paracoccidioides brasiliensis", "correct": false}], "correct_answer": "A. Sporothrix schenckii", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/0FZbRr3wOygyvv6BJtbd1746449168.png", "https://image.prepladder.com/notes/Hn39NqracG4hkQCdzi941746449377.png", "https://image.prepladder.com/notes/wBtJnNAMuiItKxyhS4Jw1746449296.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:726px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Sporotrichosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causative agent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dimorphic <span class=\"customMeta\" data-dictid=\"618e9d3b6416927772031d0260310e\">fungus</span> Sporothrix schenckii.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Epidemiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common in <strong>gardeners, forest workers</strong>, and manual labourers.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Route of transmission</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Minor trauma or thorn prick.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Chronic infection affects cutaneous, subcutaneous, and <span class=\"customMeta\" data-dictid=\"4fb6bd90f016927771918d4a2993ed\">lymphatic</span> tissue.</li>\n<li>Lesions <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> at sites of minor trauma or thorn pricks, starting as nodules.</li>\n<li>Nodules <span class=\"customMeta\" data-dictid=\"8ff7e19ae9169277720147c54e6777\">ulcerate</span> and necrose; infection spreads through <span class=\"customMeta\" data-dictid=\"4fb6bd90f016927771918d4a2993ed\">lymphatic</span> channels.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"PMI005\" data-author=\"Fichman, Vivian &amp; Valle, Antonio &amp; de Macedo, Priscila &amp; Freitas, Dayvison &amp; Oliveira, Manoel &amp; Paes, Rodrigo &amp; Galhardo, Maria Clara.\" data-hash=\"12036\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/a-Case-2-presenting-lymphocutaneous-sporotrichosis-in-the-arm-b-The-same-patient-with_fig1_324711040\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/0FZbRr3wOygyvv6BJtbd1746449168.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>Lymphocutaneous sporotrichosis: Secondary ulcers on <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes; lymphatics become hardened and cord-like.</li>\n<li>Systemic dissemination: Can affect bones, joints, and meninges.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Specimens</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Aspiration from nodules and <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> material.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Microscopy:</strong></p>\n<ul>\n<li>KOH mounts or histopathological sections stained by <span class=\"customMeta\" data-dictid=\"cb3712727816927771925665b0b1e0\">methenamine</span> silver <span class=\"customMeta\" data-dictid=\"b29a1a16ab1692777199ede1c6e28b\">stain</span> show <strong>asteroid bodies (Splendore hoeppli phenomenon)</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"PA700\" data-author=\"Nephron \" data-hash=\"12040\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Asteroid_body\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/Hn39NqracG4hkQCdzi941746449377.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Yeast phase: Cigar-shaped cells.</strong></li>\n</ul>\n<p><strong>Culture:</strong> Thin <span class=\"customMeta\" data-dictid=\"55f411a4ea1692777198d8f2de73b0\">septate</span> hyphae with flower-like clusters of small conidia; <strong>pear-shaped <span class=\"customMeta\" data-dictid=\"774c1b33a916927771844f6c75dcff\">conidia</span> in rosette-like clusters</strong> in mycelial phase.</p>\n<figure class=\"caption_element\"><img alt=\"MI596\" data-author=\"CDC/Dr. Libero Ajello\" data-hash=\"12037\" data-license=\"Open Access\" data-source=\"https://commons.wikimedia.org/wiki/File:Conidiophores_and_conidia_of_the_fungus_Sporothrix_schenckii_PHIL_4208_lores.jpg\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/wBtJnNAMuiItKxyhS4Jw1746449296.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<p>Serological tests: Helpful for extracutaneous or <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> infections.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Medications:</p>\n<ul>\n<li>Itraconazole</li>\n<li>Terbinafine</li>\n<li>Amphotericin B: For <span class=\"customMeta\" data-dictid=\"f4006059f916927771865569d4da7d\">disseminated</span> infection</li>\n</ul>\n<p>Cryotherapy.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the management approach for a 50-year-old male patient who has a 40 mm abdominal aortic aneurysm detected during his routine annual checkup?", "options": [{"label": "A", "text": "Urgent endovascular aneurysm repair", "correct": false}, {"label": "B", "text": "Surgery is indicated if the aneurysmal diameter is &amp;gt; 55mm", "correct": true}, {"label": "C", "text": "Urgently wheel the patient to OT for surgery", "correct": false}, {"label": "D", "text": "Surgery is indicated only if the aneurysm is &amp;gt; 77mm", "correct": false}], "correct_answer": "B. Surgery is indicated if the aneurysmal diameter is &gt; 55mm", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - Surgery is indicated if the &lt;span class=\"customMeta\" data-dictid=\"4526cf250d169277718154d51cf55e\"&gt;aneurysmal&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"afb15e4a331692777186e495b370a1\"&gt;diameter&lt;/span&gt; is &amp;gt; 55mm:</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management of <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">Abdominal</span> Aortic <span class=\"customMeta\" data-dictid=\"f2c92eaffe16927771819978aa5666\">Aneurysm</span> (AAA)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Surveillance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Small <span class=\"customMeta\" data-dictid=\"53a624e24916927771804c93f567f7\">AAAs</span> (3.0–3.9 cm):</strong> Monitor every 2–3 years using ultrasound.</li>\n<li><strong>Medium <span class=\"customMeta\" data-dictid=\"53a624e24916927771804c93f567f7\">AAAs</span> (4.0–5.4 cm):</strong> Monitor every 6–12 months with ultrasound.</li>\n<li><strong>Large <span class=\"customMeta\" data-dictid=\"53a624e24916927771804c93f567f7\">AAAs</span> (≥5.5 cm): </strong>Surgical intervention recommended; if not, frequent <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> and clinical review.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Medical Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk Factor Modification</strong>:</p>\n<ul>\n<li>Smoking Cessation</li>\n<li>Blood Pressure Control</li>\n<li>Cholesterol Management: <span class=\"customMeta\" data-dictid=\"2d286fa70b1692777199aba0434a49\">Statins</span> recommended.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Surgical Intervention (Option C &amp; D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>I<strong>ndications for Surgery: </strong></p>\n<ul>\n<li><strong>Aneurysm <span class=\"customMeta\" data-dictid=\"afb15e4a331692777186e495b370a1\">Diameter</span> ≥ 55 mm</strong> (High risk of rupture)</li>\n<li><strong>Rapid Growth: &gt; 5 mm</strong> increase in six months.</li>\n<li><strong>Symptomatic AAAs</strong>: Consider surgery.</li>\n</ul>\n<p><strong>Surgical Options</strong>:</p>\n<ul>\n<li><strong>Open <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">Surgical</span> Repair:</strong> Using a <span class=\"customMeta\" data-dictid=\"3b8daca52a16927771859646ba282e\">Dacron</span> graft, which is durable and has higher morbidity.</li>\n<li><strong>Endovascular <span class=\"customMeta\" data-dictid=\"f2c92eaffe16927771819978aa5666\">Aneurysm</span> Repair (EVAR):</strong> Less invasive, requires long-term surveillance for complications.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The remnants of Wolffian ducts in females are located in which of the following?", "options": [{"label": "A", "text": "Pouch of Douglas", "correct": false}, {"label": "B", "text": "Leaves of broad ligament", "correct": true}, {"label": "C", "text": "Uterovesical pouch", "correct": false}, {"label": "D", "text": "Iliac fossa", "correct": false}], "correct_answer": "B. Leaves of broad ligament", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 24-year-old female presents to an infertility clinic due to a history of repeated miscarriages. Subsequent investigations reveal the presence of a septate uterus. Which corrective procedure for a septate uterus has the most favorable obstetric outcome?", "options": [{"label": "A", "text": "Jones metroplasty", "correct": false}, {"label": "B", "text": "Strassmann metroplasty", "correct": false}, {"label": "C", "text": "Tompkins metroplasty", "correct": false}, {"label": "D", "text": "Transcervical resection of septum", "correct": true}], "correct_answer": "D. Transcervical resection of septum", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which one of the following is excluded from the primary survey?", "options": [{"label": "A", "text": "Measuring blood pressure", "correct": false}, {"label": "B", "text": "Removing clothes to inspect for wounds", "correct": false}, {"label": "C", "text": "Taking CT scan of the patient", "correct": true}, {"label": "D", "text": "Checking airway patency", "correct": false}], "correct_answer": "C. Taking CT scan of the patient", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - Taking &lt;span class=\"customMeta\" data-dictid=\"871577be5e169277718596f7614659\"&gt;CT scan&lt;/span&gt; of th\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What guidance should be provided to the students who have been exposed to meningococcal meningitis, considering that two girls in their class have been diagnosed with the disease?", "options": [{"label": "A", "text": "Two doses of polysaccharide vaccine", "correct": false}, {"label": "B", "text": "Antibiotic prophylaxis", "correct": true}, {"label": "C", "text": "Two doses of conjugate vaccine", "correct": false}, {"label": "D", "text": "Single dose of meningococcal vaccine", "correct": false}], "correct_answer": "B. Antibiotic prophylaxis", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 16-year-old female patient visits the outpatient department (OPD) with a complaint of never having experienced menstrual periods and experiencing regular pain. Upon examination of the perineal area, a protrusion is observed from the vaginal opening. Please identify the underlying cause for this clinical presentation", "options": [{"label": "A", "text": "Transverse septum in the proximal vagina", "correct": false}, {"label": "B", "text": "Complete vaginal atresia", "correct": false}, {"label": "C", "text": "Imperforate hymen", "correct": true}, {"label": "D", "text": "Cervical agenesis", "correct": false}], "correct_answer": "C. Imperforate hymen", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/sRdo0ffeEjTL9qjWFCvD1745232060.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypergonadotropic hypogonadism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Primary ovarian failure</li>\n</ul>\n<ul>\n<li>Resistant ovarian syndrome</li>\n</ul>\n<ul>\n<li>Galactosemia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Developmental <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> of the <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">genital</span> tract</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Müllerian <span class=\"customMeta\" data-dictid=\"133b86a0a516927771809ea08682e8\">agenesis</span> (2nd most common cause)</li>\n</ul>\n<ul>\n<li><strong>Imperforate hymen</strong> <strong>(Cryptomenorrhea)</strong></li>\n</ul>\n<ul>\n<li>Vaginal agenesis</li>\n</ul>\n<ul>\n<li>Transverse <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> septum</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypogonadotropic hypogonadism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hypothalamic and <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> dysfunction</li>\n</ul>\n<ul>\n<li>Kallmann’s syndrome</li>\n</ul>\n<ul>\n<li>Craniopharyngioma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Abnormal chromosomal pattern</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Turner’s syndrome (most common cause)</li>\n</ul>\n<ul>\n<li>Pure gonadal dysgenesis</li>\n</ul>\n<ul>\n<li>Androgen <span class=\"customMeta\" data-dictid=\"f1fcf0370516927771902bff983613\">insensitivity</span> syndrome</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements regarding intermittent claudication is accurate?", "options": [{"label": "A", "text": "Felt at rest", "correct": false}, {"label": "B", "text": "Most commonly felt in the calf muscles", "correct": true}, {"label": "C", "text": "Day-to-day distance is variable", "correct": false}, {"label": "D", "text": "Relieved after getting out of bed", "correct": false}], "correct_answer": "B. Most commonly felt in the calf muscles", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - Most commonly felt in the calf muscles:</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Boyd's <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">classification</span> of <span class=\"customMeta\" data-dictid=\"8502a8f15e16927771909160b28bf2\">intermittent</span> claudication</strong>:</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Grade</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Grade 0: Asymptomatic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>No symptoms</strong> of claudication, even with exercise</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Grade I: Mild claudication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Able to walk more than <strong>200 meters</strong> (about 650 feet) before onset of symptoms</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Grade II: Moderate claudication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Able to walk between <strong>50 and 200 meters</strong> (about 160 to 650 feet) before onset of symptoms</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Grade III: Severe claudication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Able to walk <strong>less than 50 meters </strong>(about 160 feet) before onset of symptoms</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Grade IV: Ischemic rest pain</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pain occurs at rest </strong>or with minimal exertion</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 22-year-old pregnant woman at 13 weeks of gestation informs you about accidental exposure to radiation from a chest X-ray at 7 weeks of gestation. What should be the next advise to her", "options": [{"label": "A", "text": "Continue pregnancy", "correct": true}, {"label": "B", "text": "Terminate pregnancy", "correct": false}, {"label": "C", "text": "Pre–invasive diagnostic test", "correct": false}, {"label": "D", "text": "Chromosome screening", "correct": false}], "correct_answer": "A. Continue pregnancy", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Gestational Age (weeks)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>&lt;5 rad</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>5–10 rad</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>&gt;10 rad</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>0-2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3-4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Probably None</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Low risk of <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">spontaneous</span> abortion</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5-10</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Not clinically detectable</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Possible malformations</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>11-17</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Not clinically detectable</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Risk of decreased IQ or of mental retardation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>18-27</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IQ deficits not detectable at diagnostic</p>\n<p>doses</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;27</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>None</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A labourer's second child is brought to the outpatient department (OPD) with a swollen belly and dull face appearance. He has been fed rice water in his diet mostly. Further investigations revealed low levels of serum protein and albumin. What could be the probable diagnosis?", "options": [{"label": "A", "text": "Kwashiorkor", "correct": true}, {"label": "B", "text": "Marasmus", "correct": false}, {"label": "C", "text": "Indian childhood cirrhosis", "correct": false}, {"label": "D", "text": "Kawasaki disease", "correct": false}], "correct_answer": "A. Kwashiorkor", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/oXFsFIjGLppBVxYpsTcr1746441406.png", "https://image.prepladder.com/notes/teCNyBKLJ51mpjZ4eHZ21746441446.png"], "explanation": "<table align=\"left\" cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Kwashiorkor </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Marasmus (Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pitting Edema:</strong> Characterized by swelling, often starting in the legs and feet, leaving a persistent <span class=\"customMeta\" data-dictid=\"cdb5523e491692777190f8bc3775ff\">indentation</span> when pressed.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Severe Wasting:</strong> The child appears extremely thin, with prominent bones and little body fat.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sugar Baby Appearance:</strong> The child may look deceptively healthy due to oedema, despite being malnourished.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Monkey Facies:</strong> A sunken appearance of the cheeks due to loss of fat, giving an aged look.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Muscle Wasting:</strong> Despite the swollen appearance, muscle loss is present, leading to weakness and hypotonia.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Baggy Pants Appearance:</strong> Loose, sagging skin around the <span class=\"customMeta\" data-dictid=\"a0af4564cf1692777183e503d226f6\">buttocks</span> caused by significant muscle and fat loss.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mental and Neurological Symptoms:</strong> The child is apathetic, irritable, and may have <span class=\"customMeta\" data-dictid=\"11a5eea407169277720251b8446fa7\">feeding</span> difficulties.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Alertness: </strong>Children with <span class=\"customMeta\" data-dictid=\"122de6274d169277719141ab2c8004\">marasmus</span> remain mentally alert.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hair Changes:</strong> Hair may lose colour, become thin, and show <span class=\"customMeta\" data-dictid=\"1b5a7ceea716927771815e7283e571\">alternating</span> bands of colour <strong>(\"flag sign\").</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Absence of Edema:</strong> Unlike kwashiorkor, <span class=\"customMeta\" data-dictid=\"122de6274d169277719141ab2c8004\">marasmus</span> does not involve <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> or oedema.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Skin Changes:</strong> Includes hyperpigmentation, peeling skin <strong>(\"flaky paint\" appearance),</strong> and colour changes, particularly in the buttocks, perineum, and thighs.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hypoglycemia Risk:</strong> The liver's <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> capacity to produce <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> increases the risk of low blood sugar.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gastrointestinal Issues:</strong> Anorexia, vomiting, and <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> distension. <strong>Anaemia is</strong> present due to nutritional deficiencies.</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hypothermia Risk:</strong> The child may struggle to maintain <span class=\"customMeta\" data-dictid=\"4a7581c8b01692777183819f38c633\">body temperature</span> due to energy depletion.</p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"PE151\" data-author=\"Dr. Lyle Conrad, \" data-hash=\"11926\" data-license=\"Open access\" data-source=\"https://commons.wikimedia.org/wiki/File:Starved_girl.jpg\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/oXFsFIjGLppBVxYpsTcr1746441406.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"PE152\" data-author=\"Content Providers(s): CDC/ Don Eddins,\" data-hash=\"11930\" data-license=\"Open access\" data-source=\"https://commons.wikimedia.org/wiki/File:Starved_child.jpg\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/teCNyBKLJ51mpjZ4eHZ21746441446.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:425px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Wellcome Classification </strong></p>\n<p style=\"text-align:center\"><strong>(Protein Calorie Malnutrition)</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Weight </strong></p>\n<p style=\"text-align:center\"><strong>(% of standard)</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Edema</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Present</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Absent</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">60-80</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Kwashiorkor</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Undernourished</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">&lt;60</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Marasmic Kwashiorkor</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Marasmus</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:506px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Kwashiorkor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Marasmus</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Protein <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> only</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Protein and <span class=\"customMeta\" data-dictid=\"5f526a682c16927771831cac5b3711\">calorie</span> deficiency</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6 months to 3 years</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Infants to less than one year</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Subcutaneous fat</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Present</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Absent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Edema</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Present</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Absent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fatty liver</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Enlarged <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> liver</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> liver</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ribs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Not prominent</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Prominent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Activity level</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lethargic</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Alert and irritable</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Muscle wasting</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mild or none</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Severe</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Appetite</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Poor</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Voracious feeder</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Nutritional requirements</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Adequate proteins</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Adequate fats, proteins, and carbohydrates</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hair changes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>More</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Less</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Skin appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Flaky, paint-like skin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Wrinkled, dry face</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Facial appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Moon appearance</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Wise old man appearance</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the causative organism responsible for vulval warts among the following options?", "options": [{"label": "A", "text": "Human papilloma virus", "correct": true}, {"label": "B", "text": "Herpes simplex", "correct": false}, {"label": "C", "text": "Human immunodeficiency virus", "correct": false}, {"label": "D", "text": "Cytomegalovirus", "correct": false}], "correct_answer": "A. Human papilloma virus", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/B3rLMls6EyzbFqK6xgQ61745232486.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable diagnosis for a 41-year-old female patient who presented with a twisted swelling on the scalp and face, accompanied by a pulsating sensation and a bruit heard during auscultation?", "options": [{"label": "A", "text": "Neurofibromatosis", "correct": false}, {"label": "B", "text": "Liposarcoma", "correct": false}, {"label": "C", "text": "Cirsoid Aneurysm", "correct": true}, {"label": "D", "text": "Varicocele", "correct": false}], "correct_answer": "C. Cirsoid Aneurysm", "question_images": ["https://image.prepladder.com/notes/94OoeJowq1G2l5i7ZUke1746432157.png"], "explanation_images": [], "explanation": "<p>Correct Answer C - &lt;span class=\"customMeta\" data-dictid=\"b7c89472071692777184f6f5df77f3\"&gt;Cirsoid&lt;/span&gt; Aneu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What would be your diagnosis for a 3-year-old male who has the given buccal mucosa findings and subsequently develops a rash after three days?", "options": [{"label": "A", "text": "Measles", "correct": true}, {"label": "B", "text": "Leukoplakia", "correct": false}, {"label": "C", "text": "Scarlet fever", "correct": false}, {"label": "D", "text": "Kawasaki disease", "correct": false}], "correct_answer": "A. Measles", "question_images": ["https://image.prepladder.com/notes/4QVrTfKpCWWx2MNjxX8P1746441569.png"], "explanation_images": ["https://image.prepladder.com/notes/LWUWlhBvMQ6G7KeAgcw71746441633.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:613px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Aspects </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causative agent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Measles (rubeola) </strong>is a highly <span class=\"customMeta\" data-dictid=\"6f6ef8bf7c1692777184dfdf8cf45d\">communicable</span> childhood <span class=\"customMeta\" data-dictid=\"4f279b047716927771872685599ba9\">exanthematous</span> illness caused by the <span class=\"customMeta\" data-dictid=\"7d2dc6a6df1692777192ccc6fd72b7\">measles</span> virus, an <strong>RNA virus</strong> from the <strong>Paramyxoviridae family.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Transmission</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Contact with <span class=\"customMeta\" data-dictid=\"33843a1c3716927771867f807275d2\">droplet</span> aerosols (through the <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> or conjunctiva)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathogenesis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Primary viremia</strong> occurs, resulting in infection of the <span class=\"customMeta\" data-dictid=\"77c058b3b21692777197f5fd539d12\">reticuloendothelial</span> system, followed by<strong> secondary viremia,</strong> which results in <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> symptoms.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Incubation period</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>8-12 days</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Period of infectivity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>From 3 days before to 4 days after the <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> onset.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Common in preschool children</li>\n<li><strong>Prodromal phase: </strong>Fever (before rash), rhinorrhea, conjunctival <span class=\"customMeta\" data-dictid=\"2dd9736fdf16927771849f5a925f7d\">congestion</span> and a dry hacking cough.</li>\n<li><strong>Koplik spots</strong>, <span class=\"customMeta\" data-dictid=\"0e147ef62e1692777194c4761f6194\">pathognomonic</span> for measles, appear on the <strong>2nd or 3rd day of illness </strong>as grey-white, sand-like lesions with surrounding <span class=\"customMeta\" data-dictid=\"f0f3e105661692777187df507b1f26\">erythema</span> on the <strong>buccal <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> opposite the lower second molars.</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"PE043\" data-author=\"CDC\" data-hash=\"11932\" data-license=\"OPEN ACCESS\" data-source=\"https://en.wikipedia.org/wiki/Koplik%27s_spots#/media/File:Koplik_spots,_measles_6111_lores.jpg\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/LWUWlhBvMQ6G7KeAgcw71746441633.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Rash</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The erythematous <span class=\"customMeta\" data-dictid=\"a4fdae630a16927771918eaa32d28b\">maculopapular</span> <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> in <span class=\"customMeta\" data-dictid=\"7d2dc6a6df1692777192ccc6fd72b7\">measles</span> appears on the 4th day, starting behind the ears, along the hairline, and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> cheeks, then <span class=\"customMeta\" data-dictid=\"ad56eb6e551692777199ae4ce59798\">spreading</span> to the rest of the body over the next 2-3 days.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Symptomatic and conservative (antipyretics, maintenance of hygiene, ensuring adequate fluid and <span class=\"customMeta\" data-dictid=\"39156a37b21692777183372a301aa8\">caloric</span> intake, and humidification).</p>\n<p>Vitamin A reduces the <span class=\"customMeta\" data-dictid=\"9b7604d5461692777192546af7cabd\">morbidity</span> and mortality of measles.</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the etiologic agent responsible for causing granuloma inguinale", "options": [{"label": "A", "text": "Calymmatobacterium granulomatis", "correct": true}, {"label": "B", "text": "Chlamydia trachomatis", "correct": false}, {"label": "C", "text": "Ureaplasma urealyticum", "correct": false}, {"label": "D", "text": "Treponema pallidum", "correct": false}], "correct_answer": "A. Calymmatobacterium granulomatis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following tests is utilized in contemporary obstetrics for monitoring the fetus of a mother who is Rh-negative and sensitized?", "options": [{"label": "A", "text": "Biophysical profile", "correct": false}, {"label": "B", "text": "Fetal blood sampling", "correct": false}, {"label": "C", "text": "Amniospectometry", "correct": false}, {"label": "D", "text": "MCA doppler peak systolic velocity", "correct": true}], "correct_answer": "D. MCA doppler peak systolic velocity", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not taken into consideration in ASEPSIS wound scoring?", "options": [{"label": "A", "text": "Wound swab from the site", "correct": false}, {"label": "B", "text": "Serous discharge", "correct": false}, {"label": "C", "text": "Erythema", "correct": false}, {"label": "D", "text": "Induration", "correct": true}], "correct_answer": "D. Induration", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - Induration</p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Parameters</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Score</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>A</strong>dditional treatment:</p>\n<ol>\n<li>Antibiotics</li>\n<li>Pus drainage</li>\n<li>Wound debridement</li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p>10</p>\n<p>5</p>\n<p>10</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>S</strong>erous <span class=\"customMeta\" data-dictid=\"9dd87431ba1692777186ecfb21d258\">discharge</span> - For 5 days of the first 7 days of wound infection</p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>0-5 Daily</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>E</strong>rythema - For 5 days of first 7 days of wound infection <strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>0-5 Daily</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>P</strong>urulent fluid - For 5 days of the first 7 days of wound infection</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>0-10 Daily</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>S</strong>eparation of deep tissues - For 5 days of the first 7 days of wound infection</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>0-10 Daily</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>I</strong>solation of bacteria <strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>10</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>S</strong>tay in the hospital (in-patient) &gt;14 days due to infection</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>5</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A male patient was brought to the emergency department following a fall into a manhole, resulting in injury to his perineum. He experiences a strong urge to urinate but is unable to do so. During examination, blood is observed at the opening of the urethra, and there is swelling of the penis and scrotum. Which specific area is affected by the injury?", "options": [{"label": "A", "text": "Membranous urethra rupture", "correct": false}, {"label": "B", "text": "Bulbar urethra injury", "correct": true}, {"label": "C", "text": "Prostatic urethra injury", "correct": false}, {"label": "D", "text": "Urinary bladder rupture", "correct": false}], "correct_answer": "B. Bulbar urethra injury", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/aCycOyyO2IRERdLNC88n1745234632.png"], "explanation": "<p>Correct Answer B - &lt;span class=\"customMeta\" data-dictid=\"ef00544aba1692777183bc916b1c30\"&gt;Bulbar&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"a594ff734f16927772016f656d39eb\"&gt;urethra&lt;/span&gt; injury</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Anterior Urethral Injury</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Bulbar <span class=\"customMeta\" data-dictid=\"a594ff734f16927772016f656d39eb\">urethra</span> (most common)</li>\n<li>Penile urethra</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"704\" src=\"https://image.prepladder.com/content/aCycOyyO2IRERdLNC88n1745234632.png\" width=\"705\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Common Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Straddle injuries</li>\n<li>Direct trauma</li>\n<li>Iatrogenic injuries (catheterization, cystoscopy)</li>\n<li>Penetrating trauma (stab/gunshot wounds)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hematuria (blood in urine)</li>\n<li>Penile/perineal bruising<strong> (butterfly-shaped hematoma)</strong></li>\n<li>Perineal pain</li>\n<li>Urinary <span class=\"customMeta\" data-dictid=\"b668aed705169277719744b6db8f8e\">retention</span> or difficulty voiding</li>\n<li>Possible <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> of the <span class=\"customMeta\" data-dictid=\"028d70d3e11692777195f204ee2764\">penis</span> or <span class=\"customMeta\" data-dictid=\"cd68da1b781692777198beaa259249\">scrotum</span> due to hematoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Retrograde <span class=\"customMeta\" data-dictid=\"adb08c51431692777201ab86e23b39\">Urethrography</span> (RGU)</strong>: <strong>Gold standard</strong>, shows the extent and location of injury</li>\n<li>Voiding <span class=\"customMeta\" data-dictid=\"c65af338d916927771853b83a9c9c5\">Cystourethrography</span> (VCUG): Used to assess urethral <span class=\"customMeta\" data-dictid=\"8c660f0c321692777194046901e354\">patency</span> post-repair</li>\n<li>Ultrasound: Can detect <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> or associated injuries</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the diagnosis of an 18-year-old girl who has been experiencing low-grade fever, weight loss, abdominal pain, and amenorrhea for the past six months? During examination, a pelvic mass is detected on the left side, and signs of ascites are present", "options": [{"label": "A", "text": "Tuberculosis with tubo-ovarian mass", "correct": true}, {"label": "B", "text": "Ovarian malignancy", "correct": false}, {"label": "C", "text": "Ectopic pregnancy", "correct": false}, {"label": "D", "text": "Submucous fibroid", "correct": false}], "correct_answer": "A. Tuberculosis with tubo-ovarian mass", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following should be the treatment of choice for renal cell carcinoma with a tumour less than 4 cm in size?", "options": [{"label": "A", "text": "Partial nephrectomy", "correct": true}, {"label": "B", "text": "Partial nephrectomy + Neoadjuvant chemotherapy", "correct": false}, {"label": "C", "text": "Radical nephrectomy", "correct": false}, {"label": "D", "text": "Radical nephrectomy + Postoperative radiotherapy", "correct": false}], "correct_answer": "A. Partial nephrectomy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - Partial nephrectomy</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment of RCC: RCCs are radio and chemo-resistant (Option B &amp; D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Surgical Management:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Partial <span class=\"customMeta\" data-dictid=\"26983fde4e16927771933da7b06ff9\">Nephrectomy</span> (Option A): </strong>Involves removing only the tumour while preserving the remainder of the kidney.</p>\n<p><strong>Indications: </strong></p>\n<ul>\n<li>T1 Disease(&lt;7cm)</li>\n<li>Restricted to poles</li>\n<li>RCC in <span class=\"customMeta\" data-dictid=\"9729ba172a1692777198c816c4ad9c\">solitary</span> <span class=\"customMeta\" data-dictid=\"bf1b7e7049169277720354c306d716\">functioning</span> kidney</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Radical Nephrectomy: </strong>Involves<strong> </strong>removal of the <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> with Gerota’s fascia, <span class=\"customMeta\" data-dictid=\"b83fd0c2a5169277719403617c9fdd\">para-aortic</span> nodes, and <span class=\"customMeta\" data-dictid=\"8cde7563da1692777201fca2b1f090\">ureter</span> up to the <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> brim.</p>\n<p><strong>Indications: </strong>Larger tumours or when partial <span class=\"customMeta\" data-dictid=\"26983fde4e16927771933da7b06ff9\">nephrectomy</span> is not feasible <strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ablative Techniques</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Radiofrequency <span class=\"customMeta\" data-dictid=\"eb788615bd16927771803d3841aa78\">Ablation</span> (RFA) and <span class=\"customMeta\" data-dictid=\"ef32d1f4571692777185565852b47f\">Cryoablation</span> </strong>involve destroying the tumour using extreme temperatures.</p>\n<p><strong>Indications:</strong></p>\n<ul>\n<li>Patients who are not <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> candidates</li>\n<li>Patients with small tumours (T1a lesions) (usually &lt;4 cm).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Systemic Therapy</strong></p>\n<p><strong>(For advanced/ metastatic disease)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Targeted Therapy</strong></p>\n<ul>\n<li>Tyrosine <span class=\"customMeta\" data-dictid=\"9863da498e1692777190e1c6515b48\">kinase</span> inhibitors (e.g., sunitinib, pazopanib)</li>\n<li>mTOR inhibitors (e.g., everolimus)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Immunotherapy: </strong>Immune <span class=\"customMeta\" data-dictid=\"cd249aae061692777184c11176df48\">checkpoint</span> inhibitors (e.g., nivolumab)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A woman presents to the OPD with complaints of amenorrhoea for the past one year. She has a history of postpartum hemorrhage and lactational failure. What is the probable diagnosis", "options": [{"label": "A", "text": "Sheehan’s syndrome", "correct": true}, {"label": "B", "text": "Rotor syndrome", "correct": false}, {"label": "C", "text": "Prolactinoma", "correct": false}, {"label": "D", "text": "Acromegaly", "correct": false}], "correct_answer": "A. Sheehan’s syndrome", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the cause of the greenish-black color of the initial stool in a newborn?", "options": [{"label": "A", "text": "Bilirubin", "correct": false}, {"label": "B", "text": "Biliverdin", "correct": true}, {"label": "C", "text": "Meconium", "correct": false}, {"label": "D", "text": "Gut flora of neonate", "correct": false}], "correct_answer": "B. Biliverdin", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "According to current recommended dietary guidelines for children, energy from saturated fats should be what percentage of total energy intake?", "options": [{"label": "A", "text": "&amp;lt; 10%", "correct": true}, {"label": "B", "text": "&amp;lt; 5%", "correct": false}, {"label": "C", "text": "&amp;lt; 15%", "correct": false}, {"label": "D", "text": "&amp;lt; 30%", "correct": false}], "correct_answer": "A. &lt; 10%", "question_images": [], "explanation_images": [], "explanation": "<table align=\"left\" cellspacing=\"0\" style=\"border-collapse:collapse; width:440px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Macronutrient</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Age 1 to 3 years</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Age 4 to 18 years</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Carbohydrates</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>45- 65 %</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>45- 65 %</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fats </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>30- 40 %</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>25- 35 %</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Protein</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>5- 20 %</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>10- 30 %</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the contraceptive shown in the given image.", "options": [{"label": "A", "text": "Male condom", "correct": false}, {"label": "B", "text": "Female condom", "correct": true}, {"label": "C", "text": "Diaphragm", "correct": false}, {"label": "D", "text": "Cervical cap", "correct": false}], "correct_answer": "B. Female condom", "question_images": ["https://image.prepladder.com/content/7bZirS1bf8fQ8Tv6zHzV1745235484.png"], "explanation_images": ["https://image.prepladder.com/content/2rloteluZThMa36os4Qt1745235565.png", "https://image.prepladder.com/content/lkakyrMv3E2RccVGluZd1745235571.png", "https://image.prepladder.com/content/TpOnl5lEDxe15aKaOoFw1745235578.png", "https://image.prepladder.com/notes/1t9YX81i9AhDypAChjwp1746445723.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The mother brought her 3-year-old daughter to seek medical attention due to the girl's enlarged clitoris. The results of the karyotype test showed a 46XX pattern. What is the probable underlying cause for this condition?", "options": [{"label": "A", "text": "21 hydroxylase deficiency", "correct": true}, {"label": "B", "text": "11 hydroxylase deficiency", "correct": false}, {"label": "C", "text": "3 beta dehydrogenase deficiency", "correct": false}, {"label": "D", "text": "17α-OH deficiency", "correct": false}], "correct_answer": "A. 21 hydroxylase deficiency", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/wgyJwGBTjal7deTUae7a1746441801.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>21-Hydroxylase Deficiency</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Most common</strong> <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of <strong>congenital <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> <span class=\"customMeta\" data-dictid=\"4c5d5ef6c31692777189820d4b320d\">hyperplasia</span> (CAH)</strong> (90%)</li>\n<li>Enzyme Affected: <strong>21-hydroxylase</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>21-hydroxylase deficiency</strong> impairs the <span class=\"customMeta\" data-dictid=\"3fda45538a1692777199ec2a5478a5\">synthesis</span> of <span class=\"customMeta\" data-dictid=\"1698cefc83169277718522e3f5fd61\">cortisol</span> and aldosterone.</li>\n<li>Low <span class=\"customMeta\" data-dictid=\"1698cefc83169277718522e3f5fd61\">cortisol</span> levels lead to elevated <span class=\"customMeta\" data-dictid=\"55fd11666f1692777180e80135bda8\">ACTH</span> levels.</li>\n<li>Elevated <span class=\"customMeta\" data-dictid=\"55fd11666f1692777180e80135bda8\">ACTH</span> causes the accumulation of <span class=\"customMeta\" data-dictid=\"a48ce797cd1692777199efc43b3e4c\">steroid</span> precursors, including <span class=\"customMeta\" data-dictid=\"2fe6989cf11692777185a228349602\">dehydroepiandrosterone</span> (DHEA), androstenedione, and 17-hydroxyprogesterone (17-OHP).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Salt <span class=\"customMeta\" data-dictid=\"9971eacaaf1692777202d2ece15a2a\">wasting</span> form:</strong> Severe <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> with nearly absent <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> activity.\n\t\t\t\t<ul>\n<li>Presents in neonates with salt-wasting, virilization,<strong> <span class=\"customMeta\" data-dictid=\"572b7955301692777181b851625681\">ambiguous genitalia</span> in girls,</strong> failure to thrive, polyuria, hyperpigmentation, critical <span class=\"customMeta\" data-dictid=\"2e0552462e16927771871413861fb7\">electrolyte</span> imbalances and shock. Diagnosis may be missed in boys.</li>\n</ul>\n</li>\n<li><strong>Simple <span class=\"customMeta\" data-dictid=\"b444230b6c16927772022f49b391b7\">virilizing</span> form:</strong> Partial <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> activity (25%) allows <span class=\"customMeta\" data-dictid=\"210102fdef1692777181bab45bdfe3\">aldosterone</span> production.\n\t\t\t\t<ul>\n<li>Features include <strong>virilization in girls and <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> <span class=\"customMeta\" data-dictid=\"58aedbfaa916927771960c11064ef0\">precocious</span> <span class=\"customMeta\" data-dictid=\"c284c4252f16927771963c07a95e13\">puberty</span> in boys</strong>.</li>\n</ul>\n</li>\n<li><strong>Non-classic form:</strong> Mild <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> with mild hyperandrogenism. Symptoms include hirsutism, acne, and <span class=\"customMeta\" data-dictid=\"3a03cad6c616927771925038b55989\">menstrual</span> irregularities in adolescents.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Salt-Wasting Form: </strong>Extreme elevations of 17-OHP levels (10000-20000 ng/dL, normal &lt;200 ng/dL) in the context of clinical signs of <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> insufficiency.</li>\n<li><strong>Simple <span class=\"customMeta\" data-dictid=\"b444230b6c16927772022f49b391b7\">Virilizing</span> and <span class=\"customMeta\" data-dictid=\"9996ef505516927771937fe4ef1222\">Non</span> Classic Forms: </strong>Elevated 17-OHP levels measured before and 60 minutes after an <span class=\"customMeta\" data-dictid=\"8a99f9c37f16927771902daa814697\">intramuscular</span> <span class=\"customMeta\" data-dictid=\"55fd11666f1692777180e80135bda8\">ACTH</span> <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">injection</span> (0.25 mg).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Salt <span class=\"customMeta\" data-dictid=\"9971eacaaf1692777202d2ece15a2a\">wasting</span> and <span class=\"customMeta\" data-dictid=\"b444230b6c16927772022f49b391b7\">virilizing</span> forms treated with</p>\n<ul>\n<li>Hydrocortisone (10-15 mg/m²/day) and Fludrocortisone (0.1 mg/day).</li>\n<li>Long-acting <span class=\"customMeta\" data-dictid=\"6045a2ba311692777188aaeacafe4f\">glucocorticoid</span> preparations (dexamethasone or prednisolone) may be used after growth and <span class=\"customMeta\" data-dictid=\"c284c4252f16927771963c07a95e13\">puberty</span> are complete.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Enzyme Deficiency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mineralo</strong></p>\n<p><strong>corticoids</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>K⁺</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>BP</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Cortisol</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Sex Hormone</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Presentation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>17α-hydroxylase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>XY:</strong> <span class=\"customMeta\" data-dictid=\"06123ff61a1692777182e19b790ebc\">Atypical</span> genitalia, undescended testes</p>\n<p><strong>XX:</strong> Lacks secondary sexual development</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>21-hydroxylase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Most common</p>\n<p>Present in <strong>infancy</strong> (salt wasting) or <strong>childhood</strong> (precocious puberty)</p>\n<p><strong>XX:</strong> Virilization</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>11β-hydroxylase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓aldosterone, ↑11-deoxycorticosterone</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Present in <strong>infancy</strong> (severe hypertension) or <strong>childhood</strong> (precocious puberty)</p>\n<p><strong>XX:</strong> Virilization</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most likely diagnosis for a newborn who presents with protrusion of bowel loops through a defect in the abdominal wall located to the right side of the umbilicus?", "options": [{"label": "A", "text": "Omphalocele", "correct": false}, {"label": "B", "text": "Umbilical hernia", "correct": false}, {"label": "C", "text": "Gastroschisis", "correct": true}, {"label": "D", "text": "Ectopia vesicae", "correct": false}], "correct_answer": "C. Gastroschisis", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/B9IEc1AAap1Y9c8w2MuS1746441894.png", "https://image.prepladder.com/content/aQdZfHO6dmTliKqW8gfd1745235802.png", "https://image.prepladder.com/notes/4SeIzyosR7Q2IR6ssIHQ1746442057.png", "https://image.prepladder.com/notes/6xkgxmjInTZHsl4J99zf1746442122.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:679px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Gastroschisis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Omphalocele </strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> where the <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall fails to close, leading to <strong>herniation of intestinal loops into the <span class=\"customMeta\" data-dictid=\"2c0fb943ce16927771815ddeb9824d\">amniotic</span> cavity.</strong></p>\n<p>M/c in premature/SGA babies</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"PE423\" data-author=\"Centers for Disease Control and Prevention\" data-hash=\"11937\" data-license=\"OPEN ACCESS\" data-source=\"https://en.wikipedia.org/wiki/Gastroschisis#/media/File:Gastroschisis-web.jpg\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/B9IEc1AAap1Y9c8w2MuS1746441894.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> <span class=\"customMeta\" data-dictid=\"9ccb2fd2f31692777201e231bfda74\">ventral</span> body wall <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> where <strong>portions of the <span class=\"customMeta\" data-dictid=\"8251cf3ec316927771925d519dd348\">midgut</span> fail to return to the <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> after <span class=\"customMeta\" data-dictid=\"6c2c85ae6b16927771950809419a59\">physiological</span> herniation.</strong></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"377\" src=\"https://image.prepladder.com/content/aQdZfHO6dmTliKqW8gfd1745235802.png\" width=\"377\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Location of defect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Right paraumbilical</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Central</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sac</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Absent, <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> is exposed.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Present </strong>(if not ruptured).</p>\n<p>Sac is made of amnion, Wharton's <span class=\"customMeta\" data-dictid=\"88bc2baef31692777190f5b09925aa\">jelly</span> and peritoneum</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Free intestinal loops.</strong></p>\n<p>(Liver is not usually herniated)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Firm mass including <strong>liver, intestine</strong> and/ other organs (like stomach, spleen)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Umbilical cord</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Adjacent to the defect</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Attached to the sac</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Associated anomalies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Associated <span class=\"customMeta\" data-dictid=\"04f89c4775169277718128d3461838\">anatomic</span> defects are uncommon</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Associated abnormalities are common and include:</p>\n<ul>\n<li>Neural tube defect</li>\n<li>Cardiac abnormalities</li>\n<li>Chromosomal defect</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Detection </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Identified through <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> ultrasound.</li>\n<li>Elevated alpha-fetoprotein (AFP) levels in <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> and <span class=\"customMeta\" data-dictid=\"2c0fb943ce16927771815ddeb9824d\">amniotic</span> fluid.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated alpha-fetoprotein (AFP) concentrations in <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> and <span class=\"customMeta\" data-dictid=\"2c0fb943ce16927771815ddeb9824d\">amniotic</span> fluid, similar to gastroschisis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complication </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Affected <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> loops may be damaged due to exposure to <span class=\"customMeta\" data-dictid=\"16a98a214c16927771852d7f6c344e\">corrosive</span> <span class=\"customMeta\" data-dictid=\"2c0fb943ce16927771815ddeb9824d\">amniotic</span> fluid.</li>\n<li>Risk of <strong>volvulus</strong>, where the <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> twists around itself, compromising blood supply.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Feeding difficulties</li>\n<li>Failure to thrive</li>\n<li>Inguinal hernias</li>\n<li>Gastroesophageal reflux</li>\n<li>Occasionally esophagitis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prognosis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Favorable</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High <strong>mortality </strong>rates</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient came to the gynaecology OPD with complaints of foul-smelling frothy vaginal discharge, and intense itching. On examination, the cervix and vagina were spotted and had the appearance of a strawberry. Identify the causative organism", "options": [{"label": "A", "text": "Trichomonas vaginalis", "correct": true}, {"label": "B", "text": "Gardnerella vaginalis", "correct": false}, {"label": "C", "text": "Neisseria gonorrhoea", "correct": false}, {"label": "D", "text": "Candida albicans", "correct": false}], "correct_answer": "A. Trichomonas vaginalis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/RIdSc7ld4smVKNnEXQlF1745235756.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old female patient is presenting with wrist pain on the lateral side. On examination the following test was positive. Tendon sheaths of which two muscles have been involved?", "options": [{"label": "A", "text": "Abductor pollicis longus and extensor pollicis brevis", "correct": true}, {"label": "B", "text": "Abductor pollicis longus and extensor pollicis longus", "correct": false}, {"label": "C", "text": "Abductor pollicis brevis and extensor pollicis brevis", "correct": false}, {"label": "D", "text": "Abductor pollicis brevis and extensor pollicis longus", "correct": false}], "correct_answer": "A. Abductor pollicis longus and extensor pollicis brevis", "question_images": ["https://image.prepladder.com/content/zoPRwn0aSBqzIpWMRTH51745235856.png"], "explanation_images": ["https://image.prepladder.com/content/aPg9IPt9Wpc1lpoO3SCE1745235894.png"], "explanation": "<p>Correct Option A) &lt;span class=\"customMeta\" data-dictid=\"1a19c0413216927771801f371db10e\"&gt;Abductor&lt;/span&gt; pollicis &lt;span class=\"customMeta\" data-dictid=\"7ff574b4f61692777191fa536b5e6c\"&gt;longus&lt;/span&gt; and &lt;span class=\"customMeta\" data-dictid=\"45f9bc42ac16927771871c9dc2970a\"&gt;extensor&lt;/span&gt; pollicis brev\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The given chest x-ray is suggestive of :", "options": [{"label": "A", "text": "Tetralogy of fallot", "correct": true}, {"label": "B", "text": "Atrial septal defect", "correct": false}, {"label": "C", "text": "Ventricular septal defect", "correct": false}, {"label": "D", "text": "Ebstein’s anomaly", "correct": false}], "correct_answer": "A. Tetralogy of fallot", "question_images": ["https://image.prepladder.com/content/XHqZ5rGftrpjLQCXO3WN1745235936.png"], "explanation_images": ["https://image.prepladder.com/notes/xQSFA15YM2zT11BNYylv1746443698.png", "https://image.prepladder.com/notes/gtu4mD5kTLkf9KVOYlqc1746443786.png", "https://image.prepladder.com/content/P8nMiFd3Qp6AXPqOw7UH1745236031.png", "https://image.prepladder.com/content/w69MyHIPO04T2p9aBPND1745236031.png", "https://image.prepladder.com/notes/95aFtB4DtBQa4bJ5bgka1746443877.png", "https://image.prepladder.com/notes/mPy6elHoaj0DbcqWByBD1746443923.png", "https://image.prepladder.com/notes/gtu4mD5kTLkf9KVOYlqc1746443786.png", "https://image.prepladder.com/content/rzhwCBXI2meYWQe8jbYO1745236031.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Snowman or \"figure-of-eight\" appearance:</strong> seen in Total <span class=\"customMeta\" data-dictid=\"11b0cdbdbd1692777181cffbe7aa1b\">anomalous</span> <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> connection (TAPVC)\"</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Case courtesy of Dr Aditya Shetty\" data-hash=\"\" data-license=\"Open access\" data-source=\"https://wikem.org/wiki/File:Tapvrsnowman.jpeg\" data-tags=\"\" height=\"422\" src=\"https://image.prepladder.com/content/P8nMiFd3Qp6AXPqOw7UH1745236031.png\" width=\"447\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Ian Bickle\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/snowman-sign-1\" data-tags=\"\" height=\"448\" src=\"https://image.prepladder.com/content/w69MyHIPO04T2p9aBPND1745236031.png\" width=\"447\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Scimitar sign:</strong> seen in<strong> </strong>Partial <span class=\"customMeta\" data-dictid=\"11b0cdbdbd1692777181cffbe7aa1b\">Anomalous</span> <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">Venous</span> Connection (PAPVC)<br/>\n\t\t\t </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"RA673\" data-author=\"JVinocur\" data-hash=\"11965\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Scimitar_syndrome_CXR.jpg\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/95aFtB4DtBQa4bJ5bgka1746443877.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"RA674\" data-author=\"JVinocur\" data-hash=\"11966\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Scimitar_syndrome_CXR.jpg\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/mPy6elHoaj0DbcqWByBD1746443923.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Box-shaped</strong> <strong>heart:</strong> seen in Ebstein’s anomaly</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"PE110\" data-author=\"Dr Vincent Tatco\" data-hash=\"11964\" data-license=\"CC BY-SA 3.0\" data-source=\"https://www.wikidoc.org/index.php/File:Ebstein-anomaly-7.jpg\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/gtu4mD5kTLkf9KVOYlqc1746443786.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gooseneck deformity:</strong> seen in</p>\n<p>endocardial <span class=\"customMeta\" data-dictid=\"f4ac509de71692777185c1d0700a8b\">cushion</span> defects</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Leonard C. Blieden, Patricia A. Randall, Aldo R. Castaneda, Russell V. Lucas, Jesse E. Edwards\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.semanticscholar.org/paper/The-%22goose-neck%22-of-the-endocardial-cushion-defect%3A-Blieden-Randall/782b7d229c969273ddcb8027c5b96578b269799a/figure/0\" data-tags=\"\" height=\"264\" src=\"https://image.prepladder.com/content/rzhwCBXI2meYWQe8jbYO1745236031.png\" width=\"447\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Where in the fallopian tube does fertilization take place?", "options": [{"label": "A", "text": "Ampulla", "correct": true}, {"label": "B", "text": "Isthmus", "correct": false}, {"label": "C", "text": "Interstitial segment", "correct": false}, {"label": "D", "text": "Infundibulum", "correct": false}], "correct_answer": "A. Ampulla", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The muscle marked by the arrow in the image below is innervated by the :", "options": [{"label": "A", "text": "Dorsal scapular nerve", "correct": true}, {"label": "B", "text": "Suprascapular nerve", "correct": false}, {"label": "C", "text": "From the dorsal rami of C1", "correct": false}, {"label": "D", "text": "Subscapular nerve", "correct": false}], "correct_answer": "A. Dorsal scapular nerve", "question_images": ["https://image.prepladder.com/notes/HD2YJkNOfl70kubSMKZ91746452687.png"], "explanation_images": ["https://image.prepladder.com/content/J7JpKUCuqHn1L8UO9flN1745236079.png"], "explanation": "<p>Correct Option A) &lt;span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\"&gt;Dorsal&lt;/span&gt; scapular nerve </p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Part of <span class=\"customMeta\" data-dictid=\"1e4db8b6ad1692777183683f42d44b\">brachial</span> <span class=\"customMeta\" data-dictid=\"3a9085a5761692777195417d7c03ae\">plexus</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Branches </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Roots</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dorsal scapular nerve - <strong>C5</strong></p>\n<p>Long <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> nerve - <strong>C5</strong> to <strong>C7</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Trunks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Suprascapular nerve - <strong>C5</strong>, <strong>C6</strong></p>\n<p>Nerve to subclavius - <strong>C5</strong>, <strong>C6</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Division</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>None</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cords</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lateral <span class=\"customMeta\" data-dictid=\"f991d64bc81692777195b12eec7a84\">pectoral</span> nerve (Lateral cord: <strong>C5</strong>-<strong>C7</strong>)</p>\n<p>Upper <span class=\"customMeta\" data-dictid=\"d4c08a578f169277719902a23f9983\">subscapular</span> nerve (Posterior cord: <strong>C5,</strong> <strong>C6</strong>)</p>\n<p>Thoracodorsal nerve (Posterior cord: <strong>C6</strong>-<strong>C8</strong>)</p>\n<p>Lower <span class=\"customMeta\" data-dictid=\"d4c08a578f169277719902a23f9983\">subscapular</span> nerve (Posterior cord: <strong>C5</strong>, <strong>C6</strong>)</p>\n<p>Medial <span class=\"customMeta\" data-dictid=\"f991d64bc81692777195b12eec7a84\">pectoral</span> nerve (Medial cord: <strong>C8</strong>, <strong>T1</strong>)</p>\n<p>Medial <span class=\"customMeta\" data-dictid=\"94f1c8df1f1692777185bd6a7c3fff\">cutaneous</span> nerve of arm (Medial cord: <strong>C8</strong>, <strong>T1</strong>)</p>\n<p>Medial <span class=\"customMeta\" data-dictid=\"94f1c8df1f1692777185bd6a7c3fff\">cutaneous</span> nerve of <span class=\"customMeta\" data-dictid=\"258a5bb5841692777203cfb8e31f55\">forearm</span> (Medial cord: <strong>C8</strong>, <strong>T1</strong>)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Terminal branches</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Musculocutaneous nerve (Lateral cord, C5-C7)</p>\n<p>Axillary nerve (Posterior cord, C5, C6)</p>\n<p>Radial nerve (Posterior cord, C5-T1)</p>\n<p>Median nerve (Lateral and Medial cords, C5-T1)</p>\n<p>Ulnar nerve (Medial cord, C8, T1)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A tumor of the uncinate process of the pancreas affects which of the following vessels?", "options": [{"label": "A", "text": "Superior mesenteric artery", "correct": true}, {"label": "B", "text": "Portal vein", "correct": false}, {"label": "C", "text": "Common hepatic artery", "correct": false}, {"label": "D", "text": "Inferior mesenteric artery", "correct": false}], "correct_answer": "A. Superior mesenteric artery", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A) Superior mesenteric &lt;span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\"&gt;artery&lt;/span&gt; </p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Anatomical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Left <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> Vein</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Originates from the <span class=\"customMeta\" data-dictid=\"4fe753e1a91692777189b7bdb3e2e1\">hilum</span> of the left kidney.</p>\n<p>Travels behind the <span class=\"customMeta\" data-dictid=\"2e2fe8c6c116927771946fb9a8adb0\">pancreas</span> and splenic vein.</p>\n<p>Crosses the <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> anteriorly below the superior mesenteric artery.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Nutcracker Analogy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The left <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> is compressed between the <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> and superior mesenteric artery, resembling a nutcracker.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Can lead to left <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> hypertension.</p>\n<p>Symptoms include <span class=\"customMeta\" data-dictid=\"660645b0c91692777188bbdf3fedff\">hematuria</span> and varicocele, especially in children.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Where is the probable location of the lesion in a patient who has presented with weakness and loss of pain and temperature sensation on the right side of the face along with loss of pain and temperature sensation on the left leg?", "options": [{"label": "A", "text": "Medial medulla", "correct": false}, {"label": "B", "text": "Lateral pons", "correct": false}, {"label": "C", "text": "Medial pons", "correct": false}, {"label": "D", "text": "Lateral medulla", "correct": true}], "correct_answer": "D. Lateral medulla", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/kvRVfvc6NOi4JSdttjIN1745236300.png"], "explanation": "<p>Correct Option D) &lt;span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\"&gt;Lateral&lt;/span&gt; medu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The long left recurrent laryngeal nerve is due to the persistence of which arch artery?", "options": [{"label": "A", "text": "3rd arch", "correct": false}, {"label": "B", "text": "4th arch", "correct": false}, {"label": "C", "text": "5th arch", "correct": false}, {"label": "D", "text": "6th arch", "correct": true}], "correct_answer": "D. 6th arch", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/XuZONWPMgjgZv4iUIf4h1746453008.png"], "explanation": "<p>Correct Option D) 6th arch\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented with the extension of MCP joint and flexion of IP joints. Which muscle is affected?", "options": [{"label": "A", "text": "Extensor digitorum", "correct": false}, {"label": "B", "text": "Interossei and lumbricals", "correct": true}, {"label": "C", "text": "Abductor pollicis longus", "correct": false}, {"label": "D", "text": "Abductor pollicis brevis", "correct": false}], "correct_answer": "B. Interossei and lumbricals", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B) Interossei and lu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the child-Turcotte-Pugh class for the patient who has a serum bilirubin 2.5 mg/dl, serum albumin 3 g/dl, prothrombin time 5 seconds (INR =2), no encephalopathy, and mild ascites?", "options": [{"label": "A", "text": "Class A", "correct": false}, {"label": "B", "text": "Class B", "correct": true}, {"label": "C", "text": "Class C", "correct": false}, {"label": "D", "text": "Class D", "correct": false}], "correct_answer": "B. Class B", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Child-Turcotte-Pugh Score</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Parameters</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>3</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Encephalopathy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Grade 1-2</p>\n<p>(Minimal)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Grade 3-4</p>\n<p>(Advanced)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ascites</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mildly controlled</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Poorly controlled</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Bilirubin (mg/dL)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&lt; 2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2 - 3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt; 3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Albumin (g/dL)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt; 3.5</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3 - 3.5</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&lt; 3.5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>INR</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&lt; 1.7</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1.7 - 2.3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt; 2.3</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "According to the TNM staging, a patient with lung cancer of size 2.5 cm is staged as:", "options": [{"label": "A", "text": "T1b", "correct": false}, {"label": "B", "text": "T1c", "correct": true}, {"label": "C", "text": "T2a", "correct": false}, {"label": "D", "text": "T1a", "correct": false}], "correct_answer": "B. T1c", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - T1c:</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>AJCC 8TH Edition of <span class=\"customMeta\" data-dictid=\"d959e86070169277720092035c0155\">TNM</span> <span class=\"customMeta\" data-dictid=\"8ea2e3870f16927771990a138acbc1\">Staging</span> of Lung Carcinoma</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Primary Tumor (T)</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T1a(mi)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Minimally <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> carcinoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T1a</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>≤ 1 cm <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T1b</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1 - 2 cm <strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T1c</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2 - 3 cm</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Involvement of the main <span class=\"customMeta\" data-dictid=\"8c78ae88d11692777183752131dce3\">bronchus</span> with the involvement of carina</li>\n<li>Involvement of visceral pleura</li>\n<li>Association with <span class=\"customMeta\" data-dictid=\"7a5ca69ddf16927771829cd4e4d464\">atelectasis</span> or obstructive pneumonitis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T2a</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3 - ≤4 cm <strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T2b</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4 - ≤5 cm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>&gt; 5 - ≤7 cm OR</li>\n<li>Direct invasion of the Chest wall, <span class=\"customMeta\" data-dictid=\"80686f198416927771959402f37ba8\">Phrenic</span> nerve, Pericardium, (Or)</li>\n<li>Satellite nodules in the same lobe</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>&gt; 7 cm in greatest dimension (Or)</li>\n<li>Any tumour with invasion of the mediastinum, diaphragm, heart, great vessels, <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> laryngeal nerve, carina, trachea, oesophagus, spine (Or)</li>\n<li>Separate tumours in different lobes of the <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> lung.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lymph <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">Node</span> (N)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>N1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ipsilateral <span class=\"customMeta\" data-dictid=\"d54aac1d5516927771958b92a04d85\">peribronchial</span> and/or hilar nodes and <span class=\"customMeta\" data-dictid=\"65d8dfe7c616927771902cc9249bd7\">intrapulmonary</span> nodes</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>N2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ipsilateral <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> and/or <span class=\"customMeta\" data-dictid=\"b431f15ea816927771991371611d2f\">subcarinal</span> nodes</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>N3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Contralateral <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> or hilar; ipsilateral/contralateral scalene/supraclavicular</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Distant <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">Metastasis</span> (M)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>M1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Distant metastasis</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>M1a</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor in <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> lung or pleural/pericardial nodule/malignant effusion</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>M1b</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Single <span class=\"customMeta\" data-dictid=\"46208b1eba1692777187c85196194d\">extrathoracic</span> metastasis, including single non-regional <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> node</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>M1c</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Multiple <span class=\"customMeta\" data-dictid=\"46208b1eba1692777187c85196194d\">extrathoracic</span> <span class=\"customMeta\" data-dictid=\"ee33485c641692777192b16b999489\">metastases</span> in one or more organs</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following structures prevents the upward extension of thyroid swelling through its attachment to the thyroid cartilage?", "options": [{"label": "A", "text": "Pretracheal fascia", "correct": false}, {"label": "B", "text": "Sternothyroid", "correct": false}, {"label": "C", "text": "Thyrohyoid membrane", "correct": false}, {"label": "D", "text": "Ligament of berry", "correct": true}], "correct_answer": "D. Ligament of berry", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/y3okXLm8GPmFsMf5dQhO1745236767.png", "https://image.prepladder.com/content/A4Jk0jmmm63iNFcCEaKh1745236767.png"], "explanation": "<p>Correct Option D) &lt;span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\"&gt;Ligament&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements regarding anatomical closure is incorrect?", "options": [{"label": "A", "text": "Anatomical closure of foramen ovale is by 3 to 5 days", "correct": true}, {"label": "B", "text": "Anatomical closure of ductus venosus is by 2 to 3 weeks", "correct": false}, {"label": "C", "text": "Right umbilical vein is absent after birth", "correct": false}, {"label": "D", "text": "Anatomical closure of ductus arteriosus is by 2 to 3 weeks", "correct": false}], "correct_answer": "A. Anatomical closure of foramen ovale is by 3 to 5 days", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Zbs7gcr1f5zuhMY078n21745236907.png", "https://image.prepladder.com/content/EIFzb3MLqzbbhcEn2gJQ1745236907.png", "https://image.prepladder.com/content/NRnQrL5XAE1xUz0PgLg91745236907.png", "https://image.prepladder.com/content/ms6Z0hqzTMtwDJRcbvtk1745236907.png", "https://image.prepladder.com/content/WytMUsMiVuojPyqMNMCr1745236907.png", "https://image.prepladder.com/content/eStdVchCWoP7STttASEa1745236907.png"], "explanation": "<p>Correct Option A) &lt;span class=\"customMeta\" data-dictid=\"116f86834a1692777181a914379270\"&gt;Anatomical&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\"&gt;closure&lt;/span&gt; of &lt;span class=\"customMeta\" data-dictid=\"9f027343dd16927772039cf6b0c8e4\"&gt;foramen&lt;/span&gt; ovale is by 3 to 5 days</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Septum Primum </strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Formed as a sickle-shaped fold from the roof and <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">dorsal</span> wall of the <span class=\"customMeta\" data-dictid=\"6d6e7d903b169277719662541dd5e2\">primitive</span> <span class=\"customMeta\" data-dictid=\"a8d33da8541692777182ec6983d9a2\">atrium</span> due to pressure from the <span class=\"customMeta\" data-dictid=\"8a32b08106169277718369e05f4a6e\">bulbus</span> cordis.</li>\n<li>Grows downward toward the <span class=\"customMeta\" data-dictid=\"d77b211e3a1692777182121ece27fc\">atrioventricular</span> (AV) <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> and <span class=\"customMeta\" data-dictid=\"d783117d991692777198108af42c05\">septum</span> intermedium, fusing with the latter.</li>\n</ul>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1600\" src=\"https://image.prepladder.com/content/NRnQrL5XAE1xUz0PgLg91745236907.png\" width=\"1600\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ostium Primum</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Before the <span class=\"customMeta\" data-dictid=\"d783117d991692777198108af42c05\">septum</span> primum reaches and fuses with the <span class=\"customMeta\" data-dictid=\"d783117d991692777198108af42c05\">septum</span> intermedium, a gap (foramen primum) allows <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> between the right and left atria.</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1600\" src=\"https://image.prepladder.com/content/ms6Z0hqzTMtwDJRcbvtk1745236907.png\" width=\"1600\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ostium Secundum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Upper part of the <span class=\"customMeta\" data-dictid=\"d783117d991692777198108af42c05\">septum</span> primum breaks down, creating a new gap (foramen secundum) before the <span class=\"customMeta\" data-dictid=\"9f027343dd16927772039cf6b0c8e4\">foramen</span> primum closes.<strong> </strong>The <span class=\"customMeta\" data-dictid=\"d783117d991692777198108af42c05\">septum</span> primum now has a free upper edge. <strong> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Septum Secundum </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Grows down from the roof of the atrial chamber, to the right of the <span class=\"customMeta\" data-dictid=\"d783117d991692777198108af42c05\">septum</span> primum, overlapping the free upper edge of the <span class=\"customMeta\" data-dictid=\"d783117d991692777198108af42c05\">septum</span> primum as it grows.</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1600\" src=\"https://image.prepladder.com/content/WytMUsMiVuojPyqMNMCr1745236907.png\" width=\"1600\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Foramen Ovale Formation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Overlapping <span class=\"customMeta\" data-dictid=\"d983a6cd671692777198ec423b3b90\">septa</span> create the <span class=\"customMeta\" data-dictid=\"9f027343dd16927772039cf6b0c8e4\">foramen</span> ovale, allowing blood to flow from right to left <span class=\"customMeta\" data-dictid=\"a8d33da8541692777182ec6983d9a2\">atrium</span> during <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> life, preventing left-to-right flow.</li>\n<li>Patent throughout <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> life.</li>\n</ul>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"1600\" src=\"https://image.prepladder.com/content/eStdVchCWoP7STttASEa1745236907.png\" width=\"1600\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Obliteration of <span class=\"customMeta\" data-dictid=\"9f027343dd16927772039cf6b0c8e4\">Foramen</span> Ovale</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Post-birth, the left <span class=\"customMeta\" data-dictid=\"a8d33da8541692777182ec6983d9a2\">atrium</span> receives oxygenated blood from the lungs, increasing pressure in this chamber greater than the right atrium, causing <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> of the <span class=\"customMeta\" data-dictid=\"d783117d991692777198108af42c05\">septum</span> primum and <span class=\"customMeta\" data-dictid=\"d783117d991692777198108af42c05\">septum</span> secundum, closing the <span class=\"customMeta\" data-dictid=\"9f027343dd16927772039cf6b0c8e4\">foramen</span> ovale.</li>\n<li>Annulus ovalis (adults) corresponds to the lower free edge of the <span class=\"customMeta\" data-dictid=\"d783117d991692777198108af42c05\">septum</span> secundum, while the <span class=\"customMeta\" data-dictid=\"30a1ba21881692777203de4e7b8537\">fossa</span> ovalis represents the <span class=\"customMeta\" data-dictid=\"d783117d991692777198108af42c05\">septum</span> primum.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 56-year-old female patient presented with progressive dysphagia for solids, loss of weight, and loss of appetite. A barium swallow done is given below. What is the most probable diagnosis", "options": [{"label": "A", "text": "Carcinoma esophagus", "correct": true}, {"label": "B", "text": "Diffuse esophageal spasm", "correct": false}, {"label": "C", "text": "Esophageal leiomyoma", "correct": false}, {"label": "D", "text": "Esophageal web", "correct": false}], "correct_answer": "A. Carcinoma esophagus", "question_images": ["https://image.prepladder.com/content/XGG7nOzSNH8X0FABjybS1745236738.png"], "explanation_images": ["https://image.prepladder.com/content/edfNZMkQGqaI3WSh32Vj1745236861.png", "https://image.prepladder.com/notes/b2oUfgkXb5Y7ycYb0cSV1746433113.png", "https://image.prepladder.com/content/FpyFf0ZyXVTnZp6kCwX51745236877.png", "https://image.prepladder.com/content/UNYaDjkOLvvFxVUYvMW21745236884.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Achalasia <span class=\"customMeta\" data-dictid=\"adc19c4a9b16927771836b8115874d\">Cardia</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Carcinoma Esophagus</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Esophageal Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Massively dilated esophagus</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Irregular narrowing of esophagus</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Distal <span class=\"customMeta\" data-dictid=\"6a729a105a169277718788389dbeab\">Esophagus</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Narrow lower end (\"bird beak\" sign)</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"https://prod-images-static.radiopaedia.org/images/57346336/0._big_gallery.jpeg\" data-tags=\"\" height=\"732\" src=\"https://image.prepladder.com/content/edfNZMkQGqaI3WSh32Vj1745236861.png\" width=\"386\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Malignant stricture</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Affects lower <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> sphincter</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mid-esophagus in this case</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Contour</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Smooth tapering at <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> end</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Irregular, abrupt narrowing</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Additional Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Proximal <span class=\"customMeta\" data-dictid=\"6a729a105a169277718788389dbeab\">esophagus</span> is dilated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>May show shouldering or \"apple core\" appearance (not visible in this image)</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"RA856\" data-author=\"Roberto Rafael Ovalle\" data-hash=\"11801\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/apple-core-sign\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/b2oUfgkXb5Y7ycYb0cSV1746433113.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><br/>\n<strong>Fig. Apple core appearance</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old male patient who is a known case of COPD presented with acute exacerbation and is admitted to the ICU. Which of the following statements is correct with regards to the initial management of this patient?", "options": [{"label": "A", "text": "Non-invasive PPV should be given", "correct": true}, {"label": "B", "text": "Invasive PPV should be given", "correct": false}, {"label": "C", "text": "IV corticosteroids should be administered", "correct": false}, {"label": "D", "text": "Permissive hypercapnia is allowed", "correct": false}], "correct_answer": "A. Non-invasive PPV should be given", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Investigation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Purpose/Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Arterial blood gases</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Assess severity of hypoxaemia, hypercapnia, acidaemia; guide oxygen therapy and ventilation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Chest X-ray</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Identify complications such as pneumonia, pneumothorax, or pleural effusion.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Oxygen Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Administer<strong> controlled oxygen at 24% or 28%</strong> to maintain PaO2 &gt; 8 kPa (60 mmHg) or SaO2 &gt; 90%.</li>\n<li>Regular <span class=\"customMeta\" data-dictid=\"b905d8d51416927771821f9cceb3a3\">arterial blood</span> gas monitoring to adjust therapy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Non-Invasive <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">Ventilation</span> (NIV)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Safe for mild to moderate <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> acidosis; helps reduce <span class=\"customMeta\" data-dictid=\"83e66fab2f1692777190a43a6e300f\">intubation</span> need and mortality.</li>\n<li>Not suitable for patients unable to protect their airway.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Bronchodilators</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Use nebulised short-acting β2-agonists (e.g., salbutamol, terbutaline) with anticholinergics (e.g., ipratropium).</li>\n<li>If oxygen sensitivity is a concern, use compressed air for nebulisation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Glucocorticoids</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Administer oral <span class=\"customMeta\" data-dictid=\"2d5e8899351692777196bdf7ced01d\">prednisolone</span> (30 mg for 10 days) to reduce symptoms and improve lung function.Reduces frequency and severity of exacerbations.</li>\n<li>Consider <span class=\"customMeta\" data-dictid=\"4c8be6d6b716927771948551f98378\">osteoporosis</span> <span class=\"customMeta\" data-dictid=\"bc36e9b9381692777196b5f9a2f79c\">prophylaxis</span> for repeated courses.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Antibiotic Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Indicated for increased <span class=\"customMeta\" data-dictid=\"5353537f861692777199e48431cd88\">sputum</span> purulence, volume, or breathlessness.</li>\n<li>Use simple regimens (aminopenicillin, tetracycline, macrolide); <span class=\"customMeta\" data-dictid=\"dd4d53634b1692777184851322327e\">co-amoxiclav</span> in areas with β-lactamase organisms.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Mechanical <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">Ventilation</span> (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Consider if there is a <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">reversible</span> cause, no prior <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> failure, or if <span class=\"customMeta\" data-dictid=\"0e4135f3bc1692777193047657d8c5\">NIV</span> has failed/contraindicated.</li>\n<li>Decisions should involve the patient, family, and GP.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Additional Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Diuretics for <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> oedema.</li>\n<li>Limited evidence for <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> aminophylline; consider <span class=\"customMeta\" data-dictid=\"5280ec6ae91692777182aa6322ae68\">arrhythmia</span> risk.</li>\n<li>Doxapram may be used short-term for low <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> rates.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Thrombocytopenia, eczema and recurrent infections are seen in:", "options": [{"label": "A", "text": "Wiskott-Aldrich syndrome", "correct": true}, {"label": "B", "text": "Chediak-Higashi syndrome", "correct": false}, {"label": "C", "text": "Thrombocytopenia - absent radius syndrome", "correct": false}, {"label": "D", "text": "Hermansky-Pudlak syndrome", "correct": false}], "correct_answer": "A. Wiskott-Aldrich syndrome", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 51-year-old man complains of abdominal pain and blood-stained stools. The barium study of his intestines shows the following finding. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Intussusception", "correct": true}, {"label": "B", "text": "Volvulus", "correct": false}, {"label": "C", "text": "Diverticulitis", "correct": false}, {"label": "D", "text": "Ulcerative colitis", "correct": false}], "correct_answer": "A. Intussusception", "question_images": ["https://image.prepladder.com/notes/WBYjDs0kHqOh0fnOlLJ51746433301.png"], "explanation_images": ["https://image.prepladder.com/content/2xowDBk5ZrIAaDhyyLZn1745237124.png", "https://image.prepladder.com/notes/x39NuqWDcBJIN2RZIY1r1746433382.png", "https://image.prepladder.com/content/TGBwlgLQxiOv6Ra59zZP1745237138.png", "https://image.prepladder.com/content/luAxumJadvxuKtOQhGj51745237148.png", "https://image.prepladder.com/content/FbYLmzgvDoymkZSd2TXF1745237156.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which among the following is more common in limited cutaneous systemic sclerosis when compared to diffuse cutaneous systemic sclerosis?", "options": [{"label": "A", "text": "Esophageal dysmotility", "correct": true}, {"label": "B", "text": "Myopathy", "correct": false}, {"label": "C", "text": "Interstitial lung disease", "correct": false}, {"label": "D", "text": "Scleroderma renal crisis", "correct": false}], "correct_answer": "A. Esophageal dysmotility", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Limited <span class=\"customMeta\" data-dictid=\"94f1c8df1f1692777185bd6a7c3fff\">Cutaneous</span> SSc</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Diffuse <span class=\"customMeta\" data-dictid=\"94f1c8df1f1692777185bd6a7c3fff\">Cutaneous</span> SSc</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Skin involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Indolent onset</li>\n<li>Limited to fingers, <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> to elbows, face</li>\n<li>Slow progression</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Rapid onset</li>\n<li>Diffuse: fingers, extremities, face, trunk</li>\n<li>Rapid progression</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Raynaud's phenomenon</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Antedates skin involvement, sometimes by years</li>\n<li>May be associated with critical <span class=\"customMeta\" data-dictid=\"0f670d10711692777190af4b12fac9\">ischemia</span> in the digits</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Onset coincident with skin involvement</li>\n<li>Critical <span class=\"customMeta\" data-dictid=\"0f670d10711692777190af4b12fac9\">ischemia</span> less common</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Musculoskeletal (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mild arthralgia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Severe arthralgia</li>\n<li>Carpal tunnel syndrome</li>\n<li>Tendon <span class=\"customMeta\" data-dictid=\"468709afe3169277720301878d09fd\">friction</span> rubs</li>\n<li>Frequent, early onset and progression, can be severe</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Esophageal dysmotility</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>90% of cases</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>80% of cases</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Interstitial lung disease (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Slowly progressive</li>\n<li>Generally mild</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Frequent, early onset and progression, can be severe</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pulmonary arterial hypertension</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Frequent, late, may occur as an isolated complication</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Often occurs in association with <span class=\"customMeta\" data-dictid=\"f46ba26d111692777190def3b1d80a\">interstitial</span> lung disease</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Scleroderma <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> crisis (Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Very rare</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Occurs in 15%; generally early (&lt;4 years from disease onset)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Calcinosis cutis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Frequent, prominent</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Less common, mild</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Characteristic autoantibodies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anti-centromere</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anti-topoisomerase (Scl-70), anti-RNA <span class=\"customMeta\" data-dictid=\"d419920a6616927771969805c3d65d\">polymerase</span> III</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Water hammer pulse is seen in which of the following conditions?", "options": [{"label": "A", "text": "Aortic stenosis", "correct": false}, {"label": "B", "text": "Aortic regurgitation", "correct": true}, {"label": "C", "text": "Aortic stenosis and aortic regurgitation", "correct": false}, {"label": "D", "text": "Mitral regurgitation", "correct": false}], "correct_answer": "B. Aortic regurgitation", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Signs of Aortic Regurgitation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Muller Sign </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is a visible <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> <span class=\"customMeta\" data-dictid=\"1e3e250f171692777196358cb28804\">pulsation</span> of the uvula</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Rosenbach sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Systolic pulsations of the Liver</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gerhardt's sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Systolic pulsations of the Spleen</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Quincke's sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Repeatedly <span class=\"customMeta\" data-dictid=\"1b5a7ceea716927771815e7283e571\">alternating</span> blushing and blanching of capillaries in the nail folds upon <span class=\"customMeta\" data-dictid=\"016b53d1731692777194a8d558c428\">palpation</span> (Capillary Pulsations)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Landolphi sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Alternating <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> <span class=\"customMeta\" data-dictid=\"4880e9b3761692777185e64eba797c\">constriction</span> and diastolic <span class=\"customMeta\" data-dictid=\"29a08d8f9216927771869ed797367e\">dilatation</span> of pupils</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Traube Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is pistol shot sounds that are heard while auscultating over the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> artery.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Water-Hammer pulse/ Corrigan's pulse</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Strong pulse that rises quickly and then drops off suddenly.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Duroziez Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is a to-and-fro <span class=\"customMeta\" data-dictid=\"da6b4ea38d169277719384b53c8f45\">murmur</span> heard while auscultating the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> artery.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>De-Musset sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The jarring motion of the head with each heartbeat</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The arterial blood gas analysis findings of a patient are as follows: pH=7.30, HCO3=10 mEq/L, paCO2= 30 mmHg, which is suggestive of a partially compensated metabolic acidosis. What is the mechanism for the secondary disorder?", "options": [{"label": "A", "text": "Hypoventilation causing decreased CO2 washout", "correct": true}, {"label": "B", "text": "Hyperventilation causing decreased CO2 washout", "correct": false}, {"label": "C", "text": "Increased tubular reabsorption of HCO3-", "correct": false}, {"label": "D", "text": "Increased excretion of H+", "correct": false}], "correct_answer": "A. Hypoventilation causing decreased CO2 washout", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A cystic lesion in the suprasellar region with calcification is seen on the MRI. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Craniopharyngioma", "correct": true}, {"label": "B", "text": "Pituitary adenoma", "correct": false}, {"label": "C", "text": "Meningioma", "correct": false}, {"label": "D", "text": "Oligodendroglioma", "correct": false}], "correct_answer": "A. Craniopharyngioma", "question_images": ["https://image.prepladder.com/notes/E3lPB1ytUGqWCKj9QDIE1746433599.png"], "explanation_images": ["https://image.prepladder.com/content/tyAKtMbLXv8sgCDdOWld1745237589.png", "https://image.prepladder.com/content/66Qy2fEIWH3qeVrh3uPC1745237604.png", "https://image.prepladder.com/content/R3F8nVU4B51VaIkNcxbM1745237652.png", "https://image.prepladder.com/content/i9Wlz9dPafA2tGbam3Jm1745237662.png", "https://image.prepladder.com/content/WNFZfwIe2q1Gxt5lTcgG1745237672.png", "https://image.prepladder.com/content/SPYQPeJ7PpeDraHRlwMR1745237682.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Craniopharyngioma </strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"1. Eduardo, Denislene &amp; Franco, Suyane &amp; Castro, José. 2. Gaillard F, Yap J, Elfeky M\" data-hash=\"\" data-license=\"1. CC BY 4.0 2. NA\" data-source=\"1. https://www.researchgate.net/figure/Adamantinomatous-craniopharyngioma-Contrast-enhanced-MRI-scan-showing-a-cystic-component_fig5_322507541 2. https://radiopaedia.org/articles/papillary-craniopharyngioma\" data-tags=\"\" height=\"530\" src=\"https://image.prepladder.com/content/tyAKtMbLXv8sgCDdOWld1745237589.png\" width=\"940\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>Craniopharyngiomas are <strong>suprasellar tumors</strong> that develop from remnants of the <span class=\"customMeta\" data-dictid=\"033ae9cbaf16927771858933478ef9\">craniopharyngeal</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> or <strong>Rathke’s pouch</strong>.</li>\n<li>It <span class=\"customMeta\" data-dictid=\"c6486470671692777184e25019e1f0\">compress</span> <strong>Optic chaism </strong>leads to <strong>bitemporal hemianopia.</strong></li>\n<li><strong>Adamantinomatous subtype</strong>\n<ul>\n<li>It<strong> </strong>is more common</li>\n<li>Seen in<strong> children</strong></li>\n<li>Typically appear as <strong>large, lobulated, multiloculated <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> lesions</strong> with a small enhancing solid component and<strong> calcifications</strong>.</li>\n</ul>\n</li>\n<li><strong>Papillary subtype </strong>\n<ul>\n<li>Seen in Adults</li>\n<li>Primarily solid lesion</li>\n<li>Rarely exhibit calcifications</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Pituitary <span class=\"customMeta\" data-dictid=\"c3c9726266169277718021f4f0fa16\">Adenoma</span> </strong><strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Quinn, Mark &amp; Bashari, Waiel &amp; Smith, Diarmuid &amp; Gurnell, Mark &amp; Agha, Amar. \" data-hash=\"\" data-license=\"CC BY\" data-source=\"https://www.researchgate.net/figure/MRI-Pituitary-MRI-Pituitary-showing-enlargement-of-the-left-side-of-the-pituitary_fig2_343923314\" data-tags=\"\" height=\"846\" src=\"https://image.prepladder.com/content/66Qy2fEIWH3qeVrh3uPC1745237604.png\" width=\"940\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Elthokapy M\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/pituitary-macroadenoma-64\" data-tags=\"\" height=\"665\" src=\"https://image.prepladder.com/content/R3F8nVU4B51VaIkNcxbM1745237652.png\" width=\"940\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Pituitary Microadenomas </strong></p>\n<ul>\n<li><strong>Less than 10 mm</strong> in size.</li>\n<li>Microadenomas appear <span class=\"customMeta\" data-dictid=\"ad45f1e11716927771901f3d9b18eb\">isointense</span> to the <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> on T1-weighted images and slightly <span class=\"customMeta\" data-dictid=\"6873f1dcce16927771890fcdc546b0\">hyperintense</span> on T2-weighted images.</li>\n<li>In <strong>dynamic contrast-enhanced MRI</strong>, they <strong>enhance slowly compared</strong> to the surrounding <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> gland.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Pituitary Macroadenomas</strong></p>\n<ul>\n<li><strong>Larger than 10 mm</strong> in size.</li>\n<li>Most of the macroadenomas are<strong> nonfunctioning.</strong></li>\n<li>They may cause <span class=\"customMeta\" data-dictid=\"d8216cf7571692777187baa94b8612\">endocrine</span> disturbances or <span class=\"customMeta\" data-dictid=\"c6486470671692777184e25019e1f0\">compress</span> the <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> chiasm, leading to <span class=\"customMeta\" data-dictid=\"3b17da47ce16927771831d5dde3af3\">bitemporal</span> hemianopia.</li>\n<li>Typically appear as <strong>sellar-suprasellar masses</strong> with a <strong>“snowman” </strong>or <strong>“figure of eight” </strong>appearance due to a <strong>waist at the <span class=\"customMeta\" data-dictid=\"1c1845d29e16927771860d473fc57c\">diaphragma</span> sellae</strong>.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"02db2e09e91692777198e14771cb3b\">sella</span> is usually enlarged.</li>\n<li>These tumors can invade the <span class=\"customMeta\" data-dictid=\"34f284128d1692777183e1cf6e17d7\">cavernous</span> sinuses.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Meningioma </strong><strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Gaillard F, Bell D, Thibodeau R, et al\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/dural-tail-sign-1\" data-tags=\"\" height=\"949\" src=\"https://image.prepladder.com/content/i9Wlz9dPafA2tGbam3Jm1745237662.png\" width=\"940\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Gaillard F, Baba Y, Lorente E\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/csf-cleft-sign-1\" data-tags=\"\" height=\"1035\" src=\"https://image.prepladder.com/content/WNFZfwIe2q1Gxt5lTcgG1745237672.png\" width=\"940\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>Meningiomas arise from <strong>arachnoidal cap cells</strong> in the brain and <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord coverings.</li>\n<li>They are the <strong>most common <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> tumors</strong>.</li>\n<li>Most common in females</li>\n<li>Mostly <span class=\"customMeta\" data-dictid=\"a325d0c14e16927771992fe8a96758\">sporadic</span> but can be <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to NF-2 or prior <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> irradiation.</li>\n<li>Meningiomas are <span class=\"customMeta\" data-dictid=\"bec08dbe0c16927771864d7774d7b0\">dural</span> based<strong> extra-axial </strong>masses that appear <span class=\"customMeta\" data-dictid=\"ad45f1e11716927771901f3d9b18eb\">isointense</span> to <span class=\"customMeta\" data-dictid=\"4baa7caf471692777188e7f07ce90e\">gray matter</span> on both T1 and T2-weighted images.</li>\n<li>They demonstrate intense<strong> <span class=\"customMeta\" data-dictid=\"d9ec45007b1692777189e3b26e44ca\">homogeneous</span> <span class=\"customMeta\" data-dictid=\"4749be0e3f1692777187a4b4100c1d\">enhancement</span> </strong>on post-contrast imaging, accompanied by a <strong>dural tail sign</strong>.</li>\n<li><strong>Characteristic <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> features:</strong>\n<ul>\n<li><strong>CSF <span class=\"customMeta\" data-dictid=\"7aa38569251692777184021705e8de\">cleft</span> sign </strong>(thin layer of CSF around the mass)</li>\n<li>Cortical buckling</li>\n<li>Widening of the <span class=\"customMeta\" data-dictid=\"0a5d82eeef169277719934b86fb07b\">subarachnoid</span> space with visible pial arteries/veins,</li>\n<li><strong>Hyperostosis</strong> or <span class=\"customMeta\" data-dictid=\"8f88b9c691169277718754ca072062\">erosion</span> of the calvarium.</li>\n<li><strong>Mother in law sign</strong><strong> </strong>(early <span class=\"customMeta\" data-dictid=\"4749be0e3f1692777187a4b4100c1d\">enhancement</span> during the arterial phase and remain opacified long after the <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> phase has passed)</li>\n<li>Calcification</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Oligodendroglioma </strong><strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"radhiana hassan\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiologycases.my/2020/04/15/oligodendroglioma/\" data-tags=\"\" height=\"699\" src=\"https://image.prepladder.com/content/SPYQPeJ7PpeDraHRlwMR1745237682.png\" width=\"940\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Oligodendrogliomas</strong> are <span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\">diffuse</span> infiltrating glial tumors originating from oligodendrocytes and are characterized by <strong>IDH mutations</strong> and<strong> 1p/19q codeletion</strong>.</li>\n<li>These tumors can be either <strong>WHO <span class=\"customMeta\" data-dictid=\"d4ae50897e16927771884b5c46ba7d\">grade</span> 2</strong> (well-differentiated oligodendrogliomas) or <strong>WHO <span class=\"customMeta\" data-dictid=\"d4ae50897e16927771884b5c46ba7d\">grade</span> 3</strong> (anaplastic oligodendrogliomas).</li>\n<li>Typically occurs in the <strong>frontal lobe</strong>.</li>\n<li>They are slow-growing, non-encapsulated, and tend to <span class=\"customMeta\" data-dictid=\"8fd5e2898d16927771900855b98180\">infiltrate</span> the overlying<strong> cortex</strong>.</li>\n<li><strong>CT</strong>: Oligodendrogliomas are <span class=\"customMeta\" data-dictid=\"7f06e594de1692777190bfb4be030b\">isodense</span> to <span class=\"customMeta\" data-dictid=\"11309a56bc1692777189e89a8d3041\">hypodense</span> with<strong> calcification</strong></li>\n<li><strong>MRI</strong>: Tumors are <span class=\"customMeta\" data-dictid=\"9912c2745b1692777189895dadd770\">hypointense</span> on T1 and <span class=\"customMeta\" data-dictid=\"6873f1dcce16927771890fcdc546b0\">hyperintense</span> on T2. They generally do not enhance with contrast</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32-year-old male was diagnosed with achalasia cardia. High-resolution manometry revealed massive, simultaneous, high-pressure contractions of the distal oesophagus. According to the Chicago classification, which type of achalasia does the patient have?", "options": [{"label": "A", "text": "Type II", "correct": false}, {"label": "B", "text": "Type I", "correct": false}, {"label": "C", "text": "Type IV", "correct": false}, {"label": "D", "text": "Type III", "correct": true}], "correct_answer": "D. Type III", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - Type III</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Chicago <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">Classification</span> of <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">Esophageal</span> <span class=\"customMeta\" data-dictid=\"c8c1db40c9169277719258df1a6b43\">Motility</span> (4.0)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Esophageal Disorder</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Values</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>1. Achalasia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Minimal <span class=\"customMeta\" data-dictid=\"3d46029a83169277718580263882c3\">contractility</span> <strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>IRP ≥ 15 mmHg, 100% failed peristalsis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Esophageal pan-pressurization <strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>IRP ≥ 15 mmHg, 100% failed <span class=\"customMeta\" data-dictid=\"69d8ba3cb3169277719543eceaf072\">peristalsis</span> with ≥ 20% pan-esophageal pressurisation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Spastic contractions <strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>IRP ≥ 15 mmHg, ≥ 20% <span class=\"customMeta\" data-dictid=\"1ce806f0111692777198eedf1b5824\">spastic</span> contractions (DCI &gt; 8,000 mmHg·s·cm)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>2. <span class=\"customMeta\" data-dictid=\"eedaf7d1db169277718739bd40e5c5\">Esophagogastric</span> <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">Junction</span> Outflow <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">Obstruction</span> (EGJOO)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated integrated <span class=\"customMeta\" data-dictid=\"5bc49d94df16927771975eae86de9f\">relaxation</span> pressure (IRP) with preserved peristalsis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>IRP ≥ 15 mmHg, some preserved peristalsis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>3. <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">Distal</span> <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">Esophageal</span> <span class=\"customMeta\" data-dictid=\"0338b655da16927771984b872baabb\">Spasm</span> (DES)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Premature (rapid) contractions with normal IRP<strong> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal IRP, ≥ 20% <span class=\"customMeta\" data-dictid=\"84f13673191692777196762b18e036\">premature</span> contractions (DL &lt; 4.5 s)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>4. Hypercontractile (Jackhammer) Esophagus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Extremely strong peristaltic contractions</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal IRP, ≥ 20% hypercontractile contractions (DCI &gt; 8,000 mmHg·s·cm)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>5. Ineffective <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">Esophageal</span> <span class=\"customMeta\" data-dictid=\"c8c1db40c9169277719258df1a6b43\">Motility</span> (IEM)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Weak or failed peristalsis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal IRP, &gt; 50% ineffective swallows (DCI &lt; 450 mmHg·s·cm for weak peristalsis)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>6. Absent Contractility</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Complete lack of <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> contractility</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal IRP, 100% failed peristalsis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is true about polyarteritis nodosa?", "options": [{"label": "A", "text": "Necrotising inflammation of large vessels", "correct": false}, {"label": "B", "text": "Patient has hypogammaglobulinemia", "correct": false}, {"label": "C", "text": "90% is associated with ANCA positivity", "correct": false}, {"label": "D", "text": "30% is associated with Hepatitis B", "correct": true}], "correct_answer": "D. 30% is associated with Hepatitis B", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70-year-old man with a known history of DM and HTN on regular medications presents with a history of progressively worsening dyspnoea on exertion. On examination, there’s elevated JVP, positive hepatojugular reflux, crackles at the lung bases, hepatomegaly, ascites and pedal oedema. What is your provisional diagnosis?", "options": [{"label": "A", "text": "Heart failure", "correct": true}, {"label": "B", "text": "Hypertrophic cardiomyopathy", "correct": false}, {"label": "C", "text": "Mitral regurgitation", "correct": false}, {"label": "D", "text": "Portal hypertension", "correct": false}], "correct_answer": "A. Heart failure", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:689px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical Features of Left-Sided vs. Right-Sided <span class=\"customMeta\" data-dictid=\"b0eb48bbf6169277718568c051e6ad\">Congestive Heart Failure</span> (CHF)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Left-Sided Heart Failure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Right-Sided Heart Failure</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causes</strong>:</p>\n<ul>\n<li>Ischemic heart disease (myocardial infarction).</li>\n<li>Hypertension</li>\n<li>Dilated cardiomyopathy.</li>\n<li>Aortic or <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> disease.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causes</strong>:</p>\n<ul>\n<li>Left-sided <span class=\"customMeta\" data-dictid=\"1a5e87d16716927771888f364bce89\">heart failure</span> (<strong>most common cause</strong>).</li>\n<li>Chronic lung diseases (COPD, <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> hypertension).</li>\n<li>Pulmonary embolism.</li>\n<li>Right <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> infarction.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>In left-sided heart failure, the left <span class=\"customMeta\" data-dictid=\"707de303e516927772011cb80f4028\">ventricle</span> cannot effectively pump blood to the body, leading to a backup of blood into the lungs.</p>\n<p> </p>\n<p><strong>Clinical features:</strong></p>\n<p>This primarily results in <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> symptoms.</p>\n<ul>\n<li><strong>Exertional dyspnea</strong></li>\n<li>Orthopnea</li>\n<li>Paroxysmal <span class=\"customMeta\" data-dictid=\"d51601f2c41692777193ddfa55d163\">nocturnal</span> dyspnea</li>\n</ul>\n<p> </p>\n<p><strong>Pulmonary Congestion:</strong></p>\n<ul>\n<li><strong>Crackles (rales) heard on <span class=\"customMeta\" data-dictid=\"b2f0dbabe516927771821b0ec5ba85\">auscultation</span> due to fluid in the alveoli.</strong></li>\n<li>Cough</li>\n<li>Wheezing (cardiac asthma).</li>\n</ul>\n<ul>\n<li>Fatigue and Weakness</li>\n<li>Decreased Exercise Tolerance</li>\n<li>Limited physical activity due to breathlessness and fatigue.</li>\n<li>S3 Gallop</li>\n</ul>\n<p> </p>\n<p><strong>Cool Extremities: </strong>Reduced <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output may cause poor <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> circulation, leading to cold, pale skin.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>In right-sided heart failure, the right <span class=\"customMeta\" data-dictid=\"707de303e516927772011cb80f4028\">ventricle</span> fails to pump blood effectively into the <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> circulation, leading to <strong>systemic <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> congestion. </strong>It is often secondary to left-sided <span class=\"customMeta\" data-dictid=\"1a5e87d16716927771888f364bce89\">heart failure</span> or conditions affecting the lungs <strong>(cor pulmonale).</strong></p>\n<p> </p>\n<p><strong>Clinical Features:</strong></p>\n<ul>\n<li>Peripheral Edema</li>\n<li><strong>Jugular <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">Venous</span> Distension (JVD) </strong></li>\n</ul>\n<ul>\n<li><strong>Hepatomegaly</strong></li>\n<li><strong>B/L <span class=\"customMeta\" data-dictid=\"a8c53e6875169277719588cd709854\">pitting</span> <span class=\"customMeta\" data-dictid=\"e272cdded916927771951d2337037d\">pedal</span> edema</strong></li>\n<li><strong>Kussmaul sign: </strong>JVP <span class=\"customMeta\" data-dictid=\"a1f256489a16927771870ddd296574\">elevation</span> on inspiration</li>\n<li><strong>Ascites</strong></li>\n<li>Nocturia</li>\n<li>Weight Gain</li>\n<li>Anorexia and Nausea</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Plethoric lung fields are seen in?", "options": [{"label": "A", "text": "TAPVC", "correct": true}, {"label": "B", "text": "Tricuspid atresia", "correct": false}, {"label": "C", "text": "Ebstein anomaly", "correct": false}, {"label": "D", "text": "TOF", "correct": false}], "correct_answer": "A. TAPVC", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Cp8YLyhl6w85GizrJcTV1745237975.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Total Anomalous <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">Venous</span> Connection (TAPVC)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pulmonary veins drain into the right <span class=\"customMeta\" data-dictid=\"a8d33da8541692777182ec6983d9a2\">atrium</span> directly or indirectly via an <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> connection</li>\n<li>Not a ductal-dependent cyanotic lesion</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sites of <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> connection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Supracardiac- superior <span class=\"customMeta\" data-dictid=\"3ddf6d5ea71692777201b70c8b9715\">vena</span> <span class=\"customMeta\" data-dictid=\"67544ba6ef16927771835d4641cc8f\">cava</span> (Most common)</li>\n<li>Cardiac-coronary sinus, right atrium</li>\n<li>Infracardiac</li>\n<li>Mixed</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cyanosis and congestive <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> failure</li>\n<li>With ASD- wide and split S2</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chest X-ray</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Snowman or figure-8 <span class=\"customMeta\" data-dictid=\"1792af7b92169277718423182d599d\">configuration</span> in supracardiac TAPVC</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Sara P. Magalhães, Nuno Moreno, Marília Loureiro, Manuela França, Fernanda Reis, Silvia Alvares, Manuel Ribeiro\" data-hash=\"\" data-license=\"CC BY-NC ND\" data-source=\"https://www.researchgate.net/figure/A-Chest-X-ray-showing-cardiomegaly-and-moderate-pulmonary-venous-congestion-B_fig3_311655923\" data-tags=\"\" height=\"541\" src=\"https://image.prepladder.com/content/Cp8YLyhl6w85GizrJcTV1745237975.png\" width=\"486\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Surgery</li>\n<li>No indication for prostaglandins (Not a ductal-dependent cyanotic lesion)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely diagnosis for a middle-aged man who comes to the emergency department with upper abdominal pain following a large meal? During clinical examination, there is tenderness in the upper abdomen, and a chest X-ray reveals a widening of the mediastinum and pneumomediastinum.", "options": [{"label": "A", "text": "Spontaneous perforation of esophagus", "correct": true}, {"label": "B", "text": "Perforation of peptic ulcer", "correct": false}, {"label": "C", "text": "Foreign body in esophagus", "correct": false}, {"label": "D", "text": "Rupture of emphysematous bulla of the lung", "correct": false}], "correct_answer": "A. Spontaneous perforation of esophagus", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - &lt;span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\"&gt;Spontaneous&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"23b5d65f051692777195987380382d\"&gt;perforation&lt;/span&gt; of esophagu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient complains of neck stiffness and severe headache. The CT image shown below is suggestive of which of the following conditions?", "options": [{"label": "A", "text": "Meningitis", "correct": false}, {"label": "B", "text": "Subarachnoid hemorrhage", "correct": true}, {"label": "C", "text": "Intraparenchymal hemorrhage", "correct": false}, {"label": "D", "text": "Hemorrhagic stroke", "correct": false}], "correct_answer": "B. Subarachnoid hemorrhage", "question_images": ["https://image.prepladder.com/content/HaXxuMLZWvwz7Qi6OjK01745238098.png"], "explanation_images": ["https://image.prepladder.com/content/ksUfoWxzqsI5v172mnGr1745238257.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Presence of blood in the <span class=\"customMeta\" data-dictid=\"0a5d82eeef169277719934b86fb07b\">subarachnoid</span> space, typically from a ruptured cerebral <span class=\"customMeta\" data-dictid=\"f2c92eaffe16927771819978aa5666\">aneurysm</span> or trauma.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Sudden, severe headache (often described as a \"thunderclap headache\")</li>\n<li>Worst headache ever experienced by the patient.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Traumatic: </strong>Head injuries causing <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> in the <span class=\"customMeta\" data-dictid=\"0a5d82eeef169277719934b86fb07b\">subarachnoid</span> space.</li>\n<li><strong>Non-Traumatic: </strong>Most commonly due to <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> of a cerebral aneurysm.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Initial Imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-Contrast CT (NCCT):</strong> First-line <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> for suspected SAH, effective in the <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> setting.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiological Findings (NCCT)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Appearance of Blood:</strong> Hyperdense (white) compared to surrounding <span class=\"customMeta\" data-dictid=\"99a9bf133e1692777184ec4b1011fe\">cerebrospinal</span> fluid (CSF).</p>\n<p>Common Sites for Blood Accumulation:</p>\n<ul>\n<li>Interhemispheric Fissure</li>\n<li>Sylvian Fissure</li>\n<li>Suprasellar Cistern</li>\n<li>Perimesencephalic Cistern</li>\n</ul>\n<p>Distinctive Shape: Blood may take on a pentagon or star shape, <span class=\"customMeta\" data-dictid=\"047f8930dd1692777197fed61e213c\">referred</span> to as the \"<strong>Star of Death.\"</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"James Heilman, MD\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Subarachnoid_hemorrhage\" data-tags=\"\" height=\"576\" src=\"https://image.prepladder.com/content/ksUfoWxzqsI5v172mnGr1745238257.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Additional Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CT Angiography:</strong> Visualizes potential aneurysms or <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> malformations; useful for <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> suspicion.</p>\n<p><strong>Digital Subtraction Angiography (DSA):</strong> Gold standard for diagnosing cerebral aneurysms; provides detailed <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> images and <span class=\"customMeta\" data-dictid=\"8dfaeedbf91692777200561b2b1d2f\">therapeutic</span> options (e.g., <span class=\"customMeta\" data-dictid=\"0dc32a9edf1692777187a82b199252\">endovascular</span> coiling).</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following causes the slowing of conduction in multiple sclerosis?", "options": [{"label": "A", "text": "Gliosis", "correct": false}, {"label": "B", "text": "Loss of myelin sheath", "correct": true}, {"label": "C", "text": "Defect at node of Ranvier", "correct": false}, {"label": "D", "text": "Leaky Na + channel", "correct": false}], "correct_answer": "B. Loss of myelin sheath", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/Y7PFi6rzA2Ftf4mSCWiX1746449621.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most frequently encountered neuroendocrine tumour in the pancreas?", "options": [{"label": "A", "text": "Gastrinoma", "correct": false}, {"label": "B", "text": "Somatostatinoma", "correct": false}, {"label": "C", "text": "Insulinoma", "correct": true}, {"label": "D", "text": "VIPoma", "correct": false}], "correct_answer": "C. Insulinoma", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Insulinoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A rare, typically<strong> <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> tumour of the pancreatic <span class=\"customMeta\" data-dictid=\"769b87740c16927771907f5a83b1f8\">islet</span> cells</strong> that produce <span class=\"customMeta\" data-dictid=\"7a1ae24f701692777187a7f60bbd9f\">excess</span> insulin.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Whipple's Triad:</strong></p>\n<ul>\n<li>Documented low blood <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> levels during <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> episodes</li>\n<li>Relief of symptoms upon administration of glucose</li>\n<li>Symptoms often occur during <span class=\"customMeta\" data-dictid=\"67f123756d16927772026c46b8d27e\">fasting</span> or after exercise</li>\n</ul>\n<p>Symptoms of <span class=\"customMeta\" data-dictid=\"78c658d4ed1692777189098c7544b9\">hypoglycemia</span> (e.g., sweating, palpitations, confusion, visual disturbances, seizures)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Gold-standard test for diagnosing <span class=\"customMeta\" data-dictid=\"43b7327590169277719092c556b0b6\">insulinoma</span> is a 72-hour fast. </strong></li>\n<li>Combination of <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> &lt; 55 mg/dL + <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> level ≥ 3 microUnits/mL + <span class=\"customMeta\" data-dictid=\"c8c9de6f88169277718395f9b4def5\">C peptide</span> level ≥ to 0.6 ng/mL + <span class=\"customMeta\" data-dictid=\"dd9e08ae7c1692777196e4ee59fee9\">proinsulin</span> ≥ 5 pmol/L, + negative <span class=\"customMeta\" data-dictid=\"552023be76169277719976e36a990e\">sulfonylurea</span> level indicates that the <span class=\"customMeta\" data-dictid=\"78c658d4ed1692777189098c7544b9\">hypoglycemia</span> <span class=\"customMeta\" data-dictid=\"f447020b9616927771904d1c923d80\">induction</span> is by hyperinsulinemia</li>\n<li><strong>Insulin/glucose ratio &gt; 0.4 is <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> </strong></li>\n<li><strong>Imaging:</strong>\n<ul>\n<li>CT, MRI, EUS</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Surgical <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> is the treatment of choice.</li>\n<li>Medical management with <span class=\"customMeta\" data-dictid=\"49eb173e4f1692777186d95adc7021\">diazoxide</span> or <span class=\"customMeta\" data-dictid=\"e705e1d6aa1692777194f6571628c6\">octreotide</span> for non-surgical candidates or unresectable tumours.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 5-year-old child with Wilson's disease is being considered for liver transplantation. Which of the following is not a parameter in the selection criteria for transplantation?", "options": [{"label": "A", "text": "Age &amp;lt; 10 years", "correct": false}, {"label": "B", "text": "PT &amp;gt; 100 s", "correct": false}, {"label": "C", "text": "Bilirubin &amp;gt; 300 μmol/L", "correct": false}, {"label": "D", "text": "Jaundice less than 7 days before the development of encephalopathy", "correct": true}], "correct_answer": "D. Jaundice less than 7 days before the development of encephalopathy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - &lt;span class=\"customMeta\" data-dictid=\"029f7520711692777190fd7d70c220\"&gt;Jaundice&lt;/span&gt; less than 7 days before the development of encephalopathy</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Laboratory measurement </strong></p>\n<p style=\"text-align: center;\"><strong>(Other options ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"> </p>\n</td>\n<td colspan=\"5\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Score (in points) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Normal value</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>4</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Serum bilirubin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">0.2-1.2 mg/dL</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">&lt;5.8</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">5.8-8.8</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">8.8-11.7</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">11.7-17.5</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">&gt;17.5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Serum <span class=\"customMeta\" data-dictid=\"3d988dbcc816927771821e9a2544f7\">aspartate</span> transferase</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">10-35 IU/L</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">&lt;100</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">100-150</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">151-200</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">201-300</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">&gt;300</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Prolongation of <span class=\"customMeta\" data-dictid=\"94b02f097916927771962072dbeeac\">prothrombin</span> time (seconds)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">&lt;4</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">4-8</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">9-12</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">13-20</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">&gt;20</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A ten-year-old boy was brought to the OPD with fever and swelling of his hands after playing football. He gives a history of previous episodes of swelling of his hands. On imaging, his spleen was found to be shrunken. Which of the following is a likely diagnosis?", "options": [{"label": "A", "text": "Sickle cell anaemia", "correct": true}, {"label": "B", "text": "Malaria", "correct": false}, {"label": "C", "text": "Pancreatitis", "correct": false}, {"label": "D", "text": "Measles", "correct": false}], "correct_answer": "A. Sickle cell anaemia", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 53-year-old woman underwent hip replacement surgery. A week after the surgery, the patient developed swelling of the legs associated with pain on palpation. Her heart rate is 70 beats per min. There is no history of hemoptysis or significant weight loss. There is no previous history of pulmonary embolism. What is the risk of developing pulmonary embolism in the patient based on Well’s score?", "options": [{"label": "A", "text": "Low", "correct": false}, {"label": "B", "text": "High", "correct": true}, {"label": "C", "text": "Moderate", "correct": false}, {"label": "D", "text": "Cannot comment without d-dimer values", "correct": false}], "correct_answer": "B. High", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:459px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Points</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clinical signs of deep-vein thrombosis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Alternative diagnosis is less likely than PE</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Heart rate &gt;100 beats/min</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1.5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Immobilization &gt;3 days or surgery in previous 4 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1.5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>History of deep-vein <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> or <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> embolism</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1.5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hemoptysis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Malignancy (with treatment within 6 months) or palliative</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:334px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Interpretation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Score Range</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Risk</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt;6.0</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intermediate</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2.0 - 6.0</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intermediate</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&lt;2.0</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which layer is accountable for preserving the moisture and clarity of the cornea?", "options": [{"label": "A", "text": "Descemet’s membrane", "correct": false}, {"label": "B", "text": "Endothelium", "correct": true}, {"label": "C", "text": "Stroma", "correct": false}, {"label": "D", "text": "Corneal epithelium", "correct": false}], "correct_answer": "B. Endothelium", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/oekmmbLRiO3UVw5CO0Z21745238992.png", "https://image.prepladder.com/content/eCtQ2afUXPpA14jlzD3n1745238998.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Layers of Cornea</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Epithelium </strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The outermost layer comprises 5-6 layers of non-keratinized, <span class=\"customMeta\" data-dictid=\"e2f163c4cd1692777199def45e74f1\">stratified</span> <span class=\"customMeta\" data-dictid=\"5be0ee4ea316927771997104326685\">squamous</span> epithelial cells.</li>\n<li>Acts as a<strong> barrier</strong>, protecting the <span class=\"customMeta\" data-dictid=\"4cc4d657841692777185555e1b982d\">cornea</span> and preventing tear fluid from entering the underlying stroma.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> cells at the <span class=\"customMeta\" data-dictid=\"799979f3bc169277719134cd535c7c\">limbus</span> are stem cells responsible for <strong>regenerating </strong>the corneal epithelium.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bowman’s Membrane</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Located just beneath the epithelium, this <span class=\"customMeta\" data-dictid=\"adb93c1540169277718043552b7de2\">acellular</span> layer is 12 µm thick and composed of densely packed <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">collagen</span> fibrils.</li>\n<li>It is a <span class=\"customMeta\" data-dictid=\"7958e897a6169277719621e27063ed\">protective barrier</span> to the <span class=\"customMeta\" data-dictid=\"c077aecdcd1692777199503c836d9c\">stroma</span> but cannot regenerate if damaged and heals by scarring.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stroma </strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Making up about 90% of the cornea's <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> (approximately 0.5 mm thick), the <span class=\"customMeta\" data-dictid=\"c077aecdcd1692777199503c836d9c\">stroma</span> consists of <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">collagen</span> fibrils arranged in <span class=\"customMeta\" data-dictid=\"635a7ea50e16927771944f08f17aed\">parallel</span> layers.</li>\n<li>These fibrils are embedded in a <span class=\"customMeta\" data-dictid=\"341e757ca9169277718922ba058b1d\">hydrated</span> <span class=\"customMeta\" data-dictid=\"14958c535b1692777192abd2a85abf\">matrix</span> of proteoglycans - <strong>Chondroitin and Keratan Sulphate </strong>(keratan sulphate maintains corneal transparency).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pre-Descemet's <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">Membrane</span> (Dua's Layer) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>This layer, discovered in 2013, is about 15 µm thick,<strong> acellular</strong>, and lies just above Descemet's membrane.</li>\n<li>It is strong and resistant to air penetration.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Descemet's <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">Membrane</span> </strong><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A <span class=\"customMeta\" data-dictid=\"e901999ab1169277719729899ebdee\">robust</span> basement <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> of the <span class=\"customMeta\" data-dictid=\"8aa7d6c2901692777185d83f2308c8\">corneal endothelium</span> is made of <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">collagen</span> and glycoproteins.</li>\n<li>It is tense, but when torn, curls inwards on itself.</li>\n<li>It can regenerate if damaged and is resistant to trauma and <span class=\"customMeta\" data-dictid=\"c0c247b89916927771948bc5e6d39c\">pathological</span> processes.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endothelium</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The innermost layer consists of a single layer of flat, hexagonal cells.</li>\n<li><strong>These cells are crucial for maintaining corneal transparency by regulating <span class=\"customMeta\" data-dictid=\"98d46770fc1692777202253fb59fe9\">fluid balance</span> within the <span class=\"customMeta\" data-dictid=\"4cc4d657841692777185555e1b982d\">cornea</span> through an active pump mechanism.</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the distinguishing characteristic of a fungal ulcer?", "options": [{"label": "A", "text": "Hypopyon", "correct": false}, {"label": "B", "text": "Dendritic ulcer on a fluorescein dye", "correct": false}, {"label": "C", "text": "Ring abscess", "correct": false}, {"label": "D", "text": "Satellite lesion", "correct": true}], "correct_answer": "D. Satellite lesion", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/aI6Ob1W1Ia2goaX3plfK1745239154.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a component of Thoracoscore?", "options": [{"label": "A", "text": "Performance status", "correct": false}, {"label": "B", "text": "Complication of surgery", "correct": true}, {"label": "C", "text": "ASA grading", "correct": false}, {"label": "D", "text": "Priority of surgery", "correct": false}], "correct_answer": "B. Complication of surgery", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - &lt;span class=\"customMeta\" data-dictid=\"8a6b09beac1692777184b08a2b5766\"&gt;Complication&lt;/span&gt; of surg\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The drug increasing uveoscleral flow is?", "options": [{"label": "A", "text": "Timolol", "correct": false}, {"label": "B", "text": "Latanoprost", "correct": true}, {"label": "C", "text": "Pilocarpine", "correct": false}, {"label": "D", "text": "Carbonic anhydrase inhibitor", "correct": false}], "correct_answer": "B. Latanoprost", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An 80-year-old woman presented with fatigue. Imaging revealed a scleroatrophic gallbladder with impacted stones and a large stone in the common bile duct, causing dilation of the biliary tree. What is the next step in management?", "options": [{"label": "A", "text": "Immediately take up the patient for cholecystectomy", "correct": false}, {"label": "B", "text": "Endoscopic retrograde cholangiopancreatography", "correct": true}, {"label": "C", "text": "Wait and watch", "correct": false}, {"label": "D", "text": "CT scan", "correct": false}], "correct_answer": "B. Endoscopic retrograde cholangiopancreatography", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/6BOOlzmJhHsHto97MOeQ1746432523.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Choledocholithiasis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Ultrasound:</strong> Useful for detecting gallstones and CBD <span class=\"customMeta\" data-dictid=\"d141b433d2169277718681e3ff6bc3\">dilation</span> but has limited sensitivity for CBD stones.</li>\n<li><strong>MRCP:</strong> Non-invasive, excellent for visualising <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> tree <span class=\"customMeta\" data-dictid=\"9e99effc421692777181b02606e021\">anatomy</span> and pathology.</li>\n<li><strong>ERCP:</strong> Highly sensitive, both <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> and <span class=\"customMeta\" data-dictid=\"8dfaeedbf91692777200561b2b1d2f\">therapeutic</span> for CBD stones.</li>\n<li><strong>PTC:</strong> Used when ERCP is not feasible, such as post-gastrectomy patients or unsuccessful ERCP attempts.</li>\n<li><strong>EUS:</strong> <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">Invasive</span> but accurate for diagnosing choledocholithiasis.</li>\n<li><strong>Blood Tests:</strong> ↑ bilirubin, ↑alkaline phosphatase, and ↑white <span class=\"customMeta\" data-dictid=\"54dd4915601692777183af673aaf7b\">blood cell count</span> indicate <span class=\"customMeta\" data-dictid=\"92128a6d941692777184f9d2f7ef4d\">choledocholithiasis</span> and possible complications like cholangitis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Endoscopic Management:</strong> ERCP with <span class=\"customMeta\" data-dictid=\"175e83e48b1692777199af3924b28b\">sphincterotomy</span> and stone extraction; stenting if necessary.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"SU074\" data-author=\"Samir धर्म \" data-hash=\"11786\" data-license=\"CC BY-SA 3.0\" data-source=\"File:ERCP stone.jpg - Wikimedia Commons\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/6BOOlzmJhHsHto97MOeQ1746432523.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Percutaneous Removal:</strong> Used when <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">endoscopic</span> access is difficult.</li>\n<li><strong>Surgery:</strong> Options include <span class=\"customMeta\" data-dictid=\"b506527af81692777191e0f69912f6\">laparoscopic</span> and open choledocholithotomy, choledochoduodenostomy, and choledochojejunostomy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Cholangitis:</strong> Bacterial infection due to obstructed <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> flow, leading to fever, chills, right upper <span class=\"customMeta\" data-dictid=\"3a757d7c1216927771968223be411d\">quadrant</span> pain, and jaundice.</li>\n<li><strong>Pancreatitis:</strong> <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">Inflammation</span> of the <span class=\"customMeta\" data-dictid=\"2e2fe8c6c116927771946fb9a8adb0\">pancreas</span> due to <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> at the <span class=\"customMeta\" data-dictid=\"3c1c3aa8b91692777181989b80fab8\">ampulla</span> of Vater.</li>\n<li><strong>Liver Damage:</strong> Prolonged <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> can cause <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> <span class=\"customMeta\" data-dictid=\"3e6e56aa3b1692777184226d2104e4\">cirrhosis</span> and liver failure.</li>\n<li><strong>Biliary Stricture:</strong> Chronic <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> can lead to the narrowing of the <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> ducts.</li>\n<li><strong>Gallstone Ileus:</strong> Large <span class=\"customMeta\" data-dictid=\"55d1a00d8c1692777188437e2069d4\">gallstone</span> eroding into the intestine, causing mechanical obstruction.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Shifting fluid sign is seen in?", "options": [{"label": "A", "text": "Exudative retinal detachment", "correct": true}, {"label": "B", "text": "Traction retinal detachment", "correct": false}, {"label": "C", "text": "Rhegmatogenous retinal detachment", "correct": false}, {"label": "D", "text": "Retinal dialysis", "correct": false}], "correct_answer": "A. Exudative retinal detachment", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/7AxS0SwJxYwhCD6HUvpn1745239641.png", "https://image.prepladder.com/content/LuGLmymLl17KNlmcHZjE1745239648.png", "https://image.prepladder.com/content/0xRYAy1SFAca6Vfrzh1O1745239655.png", "https://image.prepladder.com/content/APHaH5sIoUcPOwSJ8LSH1745239663.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Type of <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">Retinal</span> Detachment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clinical Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rhegmatogenous <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">Retinal</span> <span class=\"customMeta\" data-dictid=\"2b005085881692777186cf95c3ad51\">Detachment</span> </strong><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1.<strong> <span class=\"customMeta\" data-dictid=\"77d71e88de1692777202d4f0a3f63e\">Floaters</span> </strong>(dark spots) due to rapid <span class=\"customMeta\" data-dictid=\"636ccb4336169277720289af6a0778\">vitreous</span> degeneration.</p>\n<p>2.<strong> <span class=\"customMeta\" data-dictid=\"70b2c73b8d169277719545acd7fe2e\">Photopsia</span> </strong>(flashes of light) caused by <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> <span class=\"customMeta\" data-dictid=\"3a74ed0fcf16927771901a79847565\">irritation</span> from <span class=\"customMeta\" data-dictid=\"636ccb4336169277720289af6a0778\">vitreous</span> movements.</p>\n<p>3. Gradual <span class=\"customMeta\" data-dictid=\"d01e44abab16927772010db8725801\">visual field</span> loss, initially localized, progressing to total vision loss as <span class=\"customMeta\" data-dictid=\"2b005085881692777186cf95c3ad51\">detachment</span> spreads.</p>\n<p>4.<strong> Dark veil/cloud in front of the eye</strong>, particularly when <span class=\"customMeta\" data-dictid=\"2b005085881692777186cf95c3ad51\">detachment</span> reaches the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> region.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NYC Wanderer (Kevin Eng) \" data-hash=\"\" data-license=\"CC BY-SA 2.0\" data-source=\"https://en.wikipedia.org/wiki/Book#/media/File:Gutenberg_Bible,_Lenox_Copy,_New_York_Public_Library,_2009._Pic_01.jpg\" data-tags=\"\" height=\"300\" src=\"https://image.prepladder.com/content/7AxS0SwJxYwhCD6HUvpn1745239641.png\" width=\"434\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p>5. Sudden, painless vision loss in large, central detachment.</p>\n<p>6. <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">Retinal</span> breaks may be round, horseshoe-shaped, slit-like, or large <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> dialysis.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Jesse Vislisel, MD\" data-hash=\"\" data-license=\"CC BY NC ND 3.0\" data-source=\"https://eyerounds.org/atlas/pages/rhegmatogenous-ret-detach.htm#gsc.tab=0\" data-tags=\"\" height=\"311\" src=\"https://image.prepladder.com/content/LuGLmymLl17KNlmcHZjE1745239648.png\" width=\"436\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p>7. <span class=\"customMeta\" data-dictid=\"636ccb4336169277720289af6a0778\">Vitreous</span> pigments (tobacco dusting or <strong>Shaffer sign</strong>) are seen in the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"636ccb4336169277720289af6a0778\">vitreous</span> with <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"636ccb4336169277720289af6a0778\">vitreous</span> detachment.</p>\n<p>8. Old <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> <span class=\"customMeta\" data-dictid=\"2b005085881692777186cf95c3ad51\">detachment</span> shows <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> thinning, <span class=\"customMeta\" data-dictid=\"7c6ceacf801692777199b31cdb3fc6\">subretinal</span> <span class=\"customMeta\" data-dictid=\"6e26f8de1c1692777185d8f3885a0c\">demarcation</span> lines (high water marks), and secondary <span class=\"customMeta\" data-dictid=\"871f3dc691169277719044c0f27f98\">intraretinal</span> cysts.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tractional <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">Retinal</span> <span class=\"customMeta\" data-dictid=\"2b005085881692777186cf95c3ad51\">Detachment</span> </strong><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1. Gradual, progressive visual loss</p>\n<p>2. Typically painless</p>\n<p>3. No associated flashes or floaters</p>\n<p>4.<strong> Vitreoretinal bands present</strong></p>\n<p>5. No <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> breaks</p>\n<p>6. Detached area - <span class=\"customMeta\" data-dictid=\"9b5c0ed1601692777184e597f453c9\">concave</span> and localized</p>\n<p>7. No shifting fluid</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"359\" src=\"https://image.prepladder.com/content/0xRYAy1SFAca6Vfrzh1O1745239655.png\" width=\"359\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Exudative <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">Retinal</span> <span class=\"customMeta\" data-dictid=\"2b005085881692777186cf95c3ad51\">Detachment</span> (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1. Painless and sudden or gradual visual loss</p>\n<p>2. No photopsia, holes/ tears, folds and undulations.</p>\n<p>3. Smooth and <span class=\"customMeta\" data-dictid=\"00ab88c6091692777185ea2685fa40\">convex</span> with <span class=\"customMeta\" data-dictid=\"45d1f54a631692777195670b446c7e\">pigmentary</span> disturbances</p>\n<p>4. Rounded and fixed with <span class=\"customMeta\" data-dictid=\"176e169d7a169277719341dbc83862\">neovascularization</span> on the tumor summit.</p>\n<p>5.<strong> Shifting fluid </strong>- changing the position of the detached area with gravity - hallmark feature.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Henry Zou Lauren Fletcher-Morehouse\" data-hash=\"\" data-license=\"CC BY 3.0\" data-source=\"https://www.researchgate.net/figure/Exudative-retinal-detachment-ERD-of-both-eyes-at-one-week-post-op_fig1_362643260\" data-tags=\"\" height=\"338\" src=\"https://image.prepladder.com/content/APHaH5sIoUcPOwSJ8LSH1745239663.png\" width=\"338\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following conditions is associated with the finding observed by a physician during an eye examination of a small child?", "options": [{"label": "A", "text": "Myopia", "correct": false}, {"label": "B", "text": "Astigmatism", "correct": false}, {"label": "C", "text": "Hyperopia", "correct": true}, {"label": "D", "text": "Emmetropia", "correct": false}], "correct_answer": "C. Hyperopia", "question_images": ["https://image.prepladder.com/content/rCXHV4G7zgVtfArKrpjR1745239977.png"], "explanation_images": ["https://image.prepladder.com/content/Rs6NL4ZWCdCSMtvZ10Kd1745240051.png", "https://image.prepladder.com/content/iEUrx5aCHZGcobNqL9yP1745240059.png", "https://image.prepladder.com/content/IQ7Jrwl3jARH8IB11FYc1745240069.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What stage of Hinchey's classification is indicated when a patient with clinical features suggestive of peritonitis presents with diverticular perforation and faecal peritonitis during surgery?", "options": [{"label": "A", "text": "Stage 1", "correct": false}, {"label": "B", "text": "Stage 2", "correct": false}, {"label": "C", "text": "Stage 3", "correct": false}, {"label": "D", "text": "Stage 4", "correct": true}], "correct_answer": "D. Stage 4", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - Stage 4</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Modified Hinchey <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">Classification</span> (Severity of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> diverticulitis)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Stage 0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mild diverticulitis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Stage 1 </strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ia</strong>: <span class=\"customMeta\" data-dictid=\"b80ed09a431692777195adcab98b3b\">Pericolic</span> inflammation</p>\n<p><strong>Ib</strong>: <span class=\"customMeta\" data-dictid=\"b80ed09a431692777195adcab98b3b\">Pericolic</span> abscess</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Stage 2</strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pelvic or <span class=\"customMeta\" data-dictid=\"b02812a466169277719090c2d27868\">intra-abdominal</span> abscess</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Stage 3</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Purulent peritonitis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Stage 4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fecal peritonitis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely reason for a patient showing both unilateral and bilateral abducent palsy?", "options": [{"label": "A", "text": "Retinoblastoma", "correct": false}, {"label": "B", "text": "Orbital pseudotumor", "correct": false}, {"label": "C", "text": "Orbital cellulitis", "correct": false}, {"label": "D", "text": "Cavernous sinus thrombosis", "correct": true}], "correct_answer": "D. Cavernous sinus thrombosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/VVMU0UtNaNtYyRxXtJjI1746444695.png", "https://image.prepladder.com/notes/n6tSWPMuKZkYk8Zvoj381746444762.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Abducens Nerve (cranial nerve VI)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Motor</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Origin </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pons (lower border, opposite the <span class=\"customMeta\" data-dictid=\"70469583201692777196a8f1c66bfc\">pyramid</span> of the medulla).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Course </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><img alt=\"ANA246\" data-author=\"\" data-hash=\"11982\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/VVMU0UtNaNtYyRxXtJjI1746444695.png\"/></p>\n<p><img alt=\"POP084\" data-author=\"\" data-hash=\"11983\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/n6tSWPMuKZkYk8Zvoj381746444762.png\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Functional component</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>General <span class=\"customMeta\" data-dictid=\"3db910d8571692777198303e3bcb27\">somatic</span> <span class=\"customMeta\" data-dictid=\"8833ce72c71692777187014d5585e7\">efferent</span> fibres</strong>: Arise from the <strong>abducent nucleu</strong>s in the <span class=\"customMeta\" data-dictid=\"5e4684038e16927771967a14f73f37\">pons</span> and supply the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> muscle of the eyeball.</li>\n<li><strong>General <span class=\"customMeta\" data-dictid=\"3db910d8571692777198303e3bcb27\">somatic</span> <span class=\"customMeta\" data-dictid=\"4dd3bdfe1d1692777180deb3103555\">afferent</span> </strong>fibres carry <span class=\"customMeta\" data-dictid=\"cd38f5515716927771969b9fb17e95\">proprioceptive</span> sensations from the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> and terminate in the <span class=\"customMeta\" data-dictid=\"722dfab4551692777192ec9f24aedf\">mesencephalic</span> <span class=\"customMeta\" data-dictid=\"ff628904401692777193c8a9f9159e\">nucleus</span> of the <span class=\"customMeta\" data-dictid=\"6d1eb38ecf1692777200bb65bbdefb\">trigeminal</span> nerve.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Supply </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lateral <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> muscle of the eyeball</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical aspect </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cavernous <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> leads to <span class=\"customMeta\" data-dictid=\"493415137f1692777180adce8b5447\">abducens</span> nerve palsy</li>\n<li>Lesion or injury (elevated <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> pressure) of the <span class=\"customMeta\" data-dictid=\"493415137f1692777180adce8b5447\">abducens</span> nerve results in <span class=\"customMeta\" data-dictid=\"72fa9105b916927771945aef35e8ed\">paralysis</span> of the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> muscle, leading to:\n\t\t\t\t<ul>\n<li>Inability to <span class=\"customMeta\" data-dictid=\"cc4da2fb151692777180dc699ae203\">abduct</span> the eye</li>\n<li>Diplopia (double vision)</li>\n<li>Convergent <span class=\"customMeta\" data-dictid=\"4d366430b5169277719914874d78a5\">squint</span> (due to the unopposed action of <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> rectus)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which statement regarding retrosternal goitre is accurate?", "options": [{"label": "A", "text": "Operated in all patients regardless of symptoms", "correct": false}, {"label": "B", "text": "Sternal incision is always required to operate", "correct": false}, {"label": "C", "text": "It receives blood supply from the thoracodorsal artery", "correct": false}, {"label": "D", "text": "Most of the retrosternal goitres can be removed by a neck incision", "correct": true}], "correct_answer": "D. Most of the retrosternal goitres can be removed by a neck incision", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - Most of the &lt;span class=\"customMeta\" data-dictid=\"db0b2c70cb1692777197d6e5e33d95\"&gt;retrosternal&lt;/span&gt; goitres can be removed by a neck incision:</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Retrosternal goitre</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>A <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">enlargement</span> that extends into the <span class=\"customMeta\" data-dictid=\"be2aea1ed01692777192b46ee482a3\">mediastinum</span> behind the Sternum</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Primary: </strong>Ectopic <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> tissue in the <span class=\"customMeta\" data-dictid=\"be2aea1ed01692777192b46ee482a3\">mediastinum</span> (10%)</li>\n<li><strong>Secondary: </strong>Starts from neck and extends retrosternally (90%)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Neck <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">Swelling</span> with <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">Compression</span> Symptoms: </strong>Difficulty breathing (tracheal compression) and <span class=\"customMeta\" data-dictid=\"1788e0d4301692777199d457616bd4\">swallowing</span> (esophageal compression).</li>\n<li><strong>Pemberton Sign:</strong> <strong>Facial flushing</strong> and increased difficulty breathing when <strong>raising the arms</strong> due to <strong>thoracic <span class=\"customMeta\" data-dictid=\"42380fc2fb169277719066eff35739\">inlet</span> compression.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Physical examination:</strong> Limited <span class=\"customMeta\" data-dictid=\"016b53d1731692777194a8d558c428\">palpation</span> of the lower border of the <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> swelling.</li>\n<li><strong>Imaging:</strong> <strong>Computed <span class=\"customMeta\" data-dictid=\"8d4f2a375b1692777200f41db641bc\">Tomography</span> (CT) Scan of the Neck and Chest</strong> is <strong>IOC</strong> to assess the extent of <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> involvement and to evaluate <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> of surrounding structures.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Primary / <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">Recurrent</span> / Large <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">Malignant</span> <span class=\"customMeta\" data-dictid=\"db0b2c70cb1692777197d6e5e33d95\">Retrosternal</span> <span class=\"customMeta\" data-dictid=\"2aa25c8cad1692777188842dd483eb\">Goiter</span> - <span class=\"customMeta\" data-dictid=\"979385c98a1692777192fb1721a16e\">Median</span> <span class=\"customMeta\" data-dictid=\"012f2d780116927771993e010149ac\">Sternotomy</span> (Option B ruled out)</strong></li>\n<li><strong>Secondary <span class=\"customMeta\" data-dictid=\"db0b2c70cb1692777197d6e5e33d95\">Retrosternal</span> <span class=\"customMeta\" data-dictid=\"2aa25c8cad1692777188842dd483eb\">Goiter</span> - <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">Cervical</span> / Neck Incision</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The movement lost on left gaze as depicted in the image is seen in?", "options": [{"label": "A", "text": "3rd CN palsy", "correct": true}, {"label": "B", "text": "4th CN palsy", "correct": false}, {"label": "C", "text": "6th CN palsy", "correct": false}, {"label": "D", "text": "7th CN palsy", "correct": false}], "correct_answer": "A. 3rd CN palsy", "question_images": ["https://image.prepladder.com/content/IQKPYFG0mY7PlOXNjfrl1745240417.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Optic nerve (CN II)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Purely sensory</li>\n<li>Senses the incoming light and image displayed on retina</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Oculomotor nerve (CN III)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Innervates majority of the <span class=\"customMeta\" data-dictid=\"7d57c304c01692777187da125d18d8\">extraocular</span> muscles</li>\n<li>Motor <span class=\"customMeta\" data-dictid=\"45b8853be116927771901a9ff3eeb2\">innervation</span> to the superior <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> muscle, <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> muscle, <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> muscle, <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> <span class=\"customMeta\" data-dictid=\"dd88c7c9741692777194fe0cc9abaa\">oblique</span> muscle, <span class=\"customMeta\" data-dictid=\"fd8276624e169277719113f7a44b76\">levator</span> <span class=\"customMeta\" data-dictid=\"4f6407581c1692777194e86eb9904c\">palpebrae</span> superioris muscle, <span class=\"customMeta\" data-dictid=\"1be9f55b2d1692777184b9d813b17e\">ciliary</span> muscle, and the <span class=\"customMeta\" data-dictid=\"1a73a42f071692777199a59120f494\">sphincter</span> muscle.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Trochlear nerve (CN IV)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Motor <span class=\"customMeta\" data-dictid=\"45b8853be116927771901a9ff3eeb2\">innervation</span> to the superior <span class=\"customMeta\" data-dictid=\"dd88c7c9741692777194fe0cc9abaa\">oblique</span> muscle</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Trigeminal Nerve (CN V) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Ophthalmic branch of the <span class=\"customMeta\" data-dictid=\"6d1eb38ecf1692777200bb65bbdefb\">trigeminal</span> nerve provides <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> <span class=\"customMeta\" data-dictid=\"45b8853be116927771901a9ff3eeb2\">innervation</span> to the eye</li>\n<li>Afferent part of corneal and <span class=\"customMeta\" data-dictid=\"7b8d2e6b3a1692777191cfff333306\">lacrimation</span> reflex</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Abducens Nerve (CN VI)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Motor <span class=\"customMeta\" data-dictid=\"45b8853be116927771901a9ff3eeb2\">innervation</span> to the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> muscle</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Facial Nerve (CN VII)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Motor <span class=\"customMeta\" data-dictid=\"45b8853be116927771901a9ff3eeb2\">innervation</span> of the orbicularis <span class=\"customMeta\" data-dictid=\"7860833ed41692777194b7b9b531f7\">oculi</span> muscle</li>\n<li>Efferent part of corneal and <span class=\"customMeta\" data-dictid=\"7b8d2e6b3a1692777191cfff333306\">lacrimation</span> reflex</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sympathetic Nervous System</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Long <span class=\"customMeta\" data-dictid=\"1be9f55b2d1692777184b9d813b17e\">ciliary</span> nerves: Innervates the pupillary <span class=\"customMeta\" data-dictid=\"34cb72fd361692777186bfa0354926\">dilator</span> muscles causing mydriasis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Parasympathetic nervous system</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Short <span class=\"customMeta\" data-dictid=\"1be9f55b2d1692777184b9d813b17e\">ciliary</span> nerves:<strong> </strong>Innervates the <span class=\"customMeta\" data-dictid=\"1a73a42f071692777199a59120f494\">sphincter</span> pupillae muscles causing miosis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The lesion in which of the following nerve is responsible for right eye squint, as depicted below?", "options": [{"label": "A", "text": "Oculomotor", "correct": false}, {"label": "B", "text": "Trochlear", "correct": false}, {"label": "C", "text": "Trigeminal", "correct": false}, {"label": "D", "text": "Abducent", "correct": true}], "correct_answer": "D. Abducent", "question_images": ["https://image.prepladder.com/notes/TrSeDSHqNBQJSWClH01D1746444871.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In MEN 1 syndrome, where is the most frequent occurrence of gastrinoma observed?", "options": [{"label": "A", "text": "Jejunum", "correct": false}, {"label": "B", "text": "Ileum", "correct": false}, {"label": "C", "text": "Duodenum", "correct": true}, {"label": "D", "text": "Stomach", "correct": false}], "correct_answer": "C. Duodenum", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - Duodenu\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Multiple <span class=\"customMeta\" data-dictid=\"d8216cf7571692777187baa94b8612\">Endocrine</span> <span class=\"customMeta\" data-dictid=\"e212826c171692777193374ca34435\">Neoplasia</span> <span class=\"customMeta\" data-dictid=\"ebcb7136251692777201ef4b5c5718\">Type 1</span> (MEN Type I)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Defect of <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> <strong>11q13</strong> causing <strong>MEN 1 gene <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> </strong></li>\n<li>Also called <strong>Wermer’s syndrome</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Tumors</strong></p>\n<p style=\"text-align: center;\"><strong>Included</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Parathyroid adenoma</strong></p>\n<p>(Most common)</p>\n<ul>\n<li>It presents with primary <span class=\"customMeta\" data-dictid=\"a21c150dc716927771893624a49628\">hyperparathyroidism</span> (↑ <span class=\"customMeta\" data-dictid=\"5eff25235516927771968c590529d7\">PTH</span> and ↑ Ca)</li>\n<li>All the four glands can be included.</li>\n<li><strong>Rx: </strong>Total/subtotal <span class=\"customMeta\" data-dictid=\"3bcd005ca116927771941ae5bca4a8\">parathyroid</span> resection</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pancreatic adenoma</strong></p>\n<ul>\n<li>Presents as <strong>Gastrinoma or Zollinger-Ellison syndrome</strong></li>\n<li>This leads to <span class=\"customMeta\" data-dictid=\"f6768ff15f1692777195a493cad3a9\">peptic</span> <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> disease in the duodenum, which is the leading <span class=\"customMeta\" data-dictid=\"254dc5106d1692777183ba9ab1b3e5\">cause of death</span> in this type.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pituitary adenoma: </strong>Prolactinoma, causing <span class=\"customMeta\" data-dictid=\"5d8a1011e31692777181375a96c9c8\">amenorrhea</span> and Infertility</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Associated conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Angiofibroma</li>\n<li>Collagenoma</li>\n<li>Adrenocortical tumor</li>\n<li>Carcinoid tumors/Argentaffinoma</li>\n<li>Pheochromocytoma (only in 1%)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A mutation in the gene for the aquaporin channel leads to which of the following conditions?", "options": [{"label": "A", "text": "Liddle’s syndrome", "correct": false}, {"label": "B", "text": "Nephrogenic DI", "correct": true}, {"label": "C", "text": "Cystic fibrosis", "correct": false}, {"label": "D", "text": "Barter syndrome", "correct": false}], "correct_answer": "B. Nephrogenic DI", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - &lt;span class=\"customMeta\" data-dictid=\"8544e173991692777193d9a5472b4f\"&gt;Nephrogenic&lt;/span&gt; DI</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Central DI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Nephrogenic DI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Primary Polydipsia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Gestational DI</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Deficiency of <span class=\"customMeta\" data-dictid=\"3d529926ea1692777182d044bda305\">AVP</span> (Arginine vasopressin) <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> from the <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> gland.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Kidneys are unable to respond to AVP, even if levels are normal.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Excessive water intake, suppressing <span class=\"customMeta\" data-dictid=\"3d529926ea1692777182d044bda305\">AVP</span> secretion.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased activity of <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> degrading <span class=\"customMeta\" data-dictid=\"3d529926ea1692777182d044bda305\">AVP</span> during pregnancy.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Acquired</strong>: Head trauma, tumours, granulomas, infections, inflammation, toxins, <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> events, hypoxia.</p>\n<p> </p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Acquired</strong>: Drugs (lithium, demeclocycline), <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> disorders (hypercalcaemia, hypokalaemia), obstruction, <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> issues, granulomas, tumours, and infiltration.</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dipsogenic</strong>: Inappropriate thirst, head trauma, brain diseases.</p>\n</td>\n<td rowspan=\"6\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> <span class=\"customMeta\" data-dictid=\"6937cb294a1692777201467ccb0597\">vasopressinase</span> activity.</p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Psychogenic</strong>: Psychiatric conditions, <span class=\"customMeta\" data-dictid=\"8e09a4a39b1692777184e5e57a8435\">compulsive</span> water drinking.</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Genetic</strong>: Mutations in the AVP–neurophysin II or WFS1 genes.</p>\n<p> </p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Genetic:</strong> Mutations in the <strong>V2 <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> or aquaporin-2 genes.</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Iatrogenic</strong>: Belief in the health benefits of excessive water intake.</p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Basal <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">Plasma</span> AVP</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low or undetectable (&lt;1 pg/mL).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal or elevated (&gt;1 pg/mL).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low due to <span class=\"customMeta\" data-dictid=\"7b7c55fbdd16927771990b50bda606\">suppression</span> by excessive water intake.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low due to increased degradation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Urine Osmolarity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low (&lt;280 mOsm/L).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low (&lt;280 mOsm/L).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low (&lt;280 mOsm/L) but can temporarily concentrate with fluid deprivation.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low (&lt;280 mOsm/L).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Plasma Osmolarity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreased</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fluid <span class=\"customMeta\" data-dictid=\"0a5bb4dd4116927771860470a5e991\">Deprivation</span> Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Urine does not concentrate.</li>\n<li>AVP or desmopressin <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">injection</span> increases <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> <span class=\"customMeta\" data-dictid=\"612769eab6169277719463af223927\">osmolarity</span> in severe CDI.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Urine does not concentrate.</li>\n<li>AVP or desmopressin <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">injection</span> has no effect on severe NDI.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Plasma <span class=\"customMeta\" data-dictid=\"612769eab6169277719463af223927\">osmolarity</span> and sodium increase above normal without <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> concentration.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Not typically performed during pregnancy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>MRI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Posterior <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> bright spot absent or small.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Posterior <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> bright- spot may be faint or absent.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Posterior <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> bright spot present.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Not routinely used for diagnosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Desmopressin (DDAVP) Trial</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Abolishes <span class=\"customMeta\" data-dictid=\"b3ede0654b1692777196abe86bdbac\">polyuria</span> and polydipsia; reduces <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> osmolarity/sodium.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No effect on <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output, fluid intake, or <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> osmolarity/sodium.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Eliminates <span class=\"customMeta\" data-dictid=\"b3ede0654b1692777196abe86bdbac\">polyuria</span> but not polydipsia, leading to hyponatremia.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Effective in controlling symptoms.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Plasma Copeptin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low or undetectable.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It may be normal or elevated.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Suppressed due to low AVP.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It may be low due to <span class=\"customMeta\" data-dictid=\"3d529926ea1692777182d044bda305\">AVP</span> degradation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Desmopressin (DDAVP).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Thiazide diuretics, amiloride, low-sodium diet, <span class=\"customMeta\" data-dictid=\"42815e46071692777196c90c46f78b\">prostaglandin</span> inhibitors.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Behavioral therapy, education about overhydration.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Desmopressin (DDAVP).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Resolution</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Lifelong treatment usually needed for <span class=\"customMeta\" data-dictid=\"0f0b2969921692777180de24f0b0c0\">acquired</span> CDI</li>\n<li>Genetic forms may improve.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Dependent on the underlying cause</li>\n<li>Lithium-induced NDI may persist.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Dependent on behavioural <span class=\"customMeta\" data-dictid=\"e480da93a016927771925dd2d9c43a\">modification</span> and addressing the underlying cause.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Usually, it resolves after delivery.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a radiological finding in a patient with left heart failure?", "options": [{"label": "A", "text": "Kerley B lines", "correct": false}, {"label": "B", "text": "Focal oligemia", "correct": true}, {"label": "C", "text": "Increased venous blood in lung", "correct": false}, {"label": "D", "text": "Change in upper lobe circulation", "correct": false}], "correct_answer": "B. Focal oligemia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/HyO5XpSJtg9iisjKoIHX1745243923.png", "https://image.prepladder.com/content/fFMOgaeOGDrrZpcJkTC31745243955.png"], "explanation": "<p>Correct Answer B - &lt;span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\"&gt;Focal&lt;/span&gt; olig\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old man presented with an episode of acute onset dizziness and loss of consciousness, which lasted for a few seconds, followed by a regain of full consciousness. There were no similar episodes in the past. Which of the following is a true statement regarding this scenario?", "options": [{"label": "A", "text": "ECG to rule out atrial fibrillation", "correct": true}, {"label": "B", "text": "If ECG is normal, CT scan should be done", "correct": false}, {"label": "C", "text": "Tilt-table testing", "correct": false}, {"label": "D", "text": "Vestibular neuritis is a possible condition that can cause these symptoms", "correct": false}], "correct_answer": "A. ECG to rule out atrial fibrillation", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - &lt;span class=\"customMeta\" data-dictid=\"40ebcbf95e169277718613d7c2d999\"&gt;ECG&lt;/span&gt; to rule ou\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 12-year-old child who is known to have type 1 diabetes mellitus presents with confusion and drowsiness. Her mother says that she seems to be breathing very fast. On examination, mucous membranes are dry, and blood pressure is 70/50 mmHg. Random blood glucose is 415 mg/d,l and urine ketones are 4+. What is the next best step in management?", "options": [{"label": "A", "text": "2-3 L of normal saline over 1-3 hours", "correct": false}, {"label": "B", "text": "Insulin infusion at 0.1 units/kg/hour", "correct": false}, {"label": "C", "text": "Arterial blood gas", "correct": true}, {"label": "D", "text": "Insulin bolus of 0.1 units/kg given", "correct": false}], "correct_answer": "C. Arterial blood gas", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - &lt;span class=\"customMeta\" data-dictid=\"b905d8d51416927771821f9cceb3a3\"&gt;Arterial blood&lt;/span&gt; gas</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Symptoms </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Signs </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Nausea, vomiting</li>\n<li>Abdominal pain</li>\n<li>Shortness of breath</li>\n<li>Thirst, polyuria</li>\n<li>Weight loss</li>\n<li>Weakness</li>\n<li>Leg cramps</li>\n<li>Blurred vision</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Tachycardia</li>\n<li>Dehydration</li>\n<li><strong>Hypotension</strong> (postural or supine)</li>\n<li><strong>Tachypnea</strong></li>\n<li><strong>Kussmaul respirations (air hunger)</strong></li>\n<li>Smell of acetone</li>\n<li>Respiratory distress</li>\n<li>Hypothermia</li>\n<li>Cold extremities/peripheral cyanosis</li>\n<li>Abdominal <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> (may resemble <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"98ea94d2c01692777194cc5ffee153\">pancreatitis</span> or <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> abdomen)</li>\n<li>Lethargy/obtundation/cerebral oedema/possibly coma</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is associated with pauci-immune glomerulonephritis?", "options": [{"label": "A", "text": "SLE nephritis", "correct": false}, {"label": "B", "text": "Anti-GBM glomerulonephritis", "correct": false}, {"label": "C", "text": "IgA nephropathy", "correct": false}, {"label": "D", "text": "Granulomatosis with polyangiitis (GPA)", "correct": true}], "correct_answer": "D. Granulomatosis with polyangiitis (GPA)", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - &lt;span class=\"customMeta\" data-dictid=\"2db4616dd0169277718891a2a1b67c\"&gt;Granulomatosis&lt;/span&gt; with &lt;span class=\"customMeta\" data-dictid=\"9a6ce977bc1692777196a292871244\"&gt;polyangiitis&lt;/span&gt; (GPA):</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Key Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Antibodies/Labs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pathology</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Granulomatosis with <span class=\"customMeta\" data-dictid=\"9a6ce977bc1692777196a292871244\">Polyangiitis</span> (GPA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Pauci-immune vasculitis</strong></li>\n<li>Upper/lower respiratory</li>\n<li><strong>Glomerulonephritis</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>PR3-ANCA</li>\n<li>c-ANCA pattern</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Granulomatous inflammation</li>\n<li>Small vessel vasculitis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Microscopic Polyangiitis</strong></p>\n<p style=\"text-align: center;\"> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pulmonary-renal syndrome</li>\n<li>No granulomas</li>\n<li>Segmental <span class=\"customMeta\" data-dictid=\"f826a1a46e1692777193319fa1e5ed\">necrotizing</span> GN</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>MPO-ANCA</li>\n<li>p-ANCA pattern</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Necrotizing vasculitis</li>\n<li>No granulomas</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Churg-Strauss Syndrome/ <span class=\"customMeta\" data-dictid=\"91bc3a9b3e16927771871bcff74db7\">Eosinophilic</span> <span class=\"customMeta\" data-dictid=\"2db4616dd0169277718891a2a1b67c\">Granulomatosis</span> with Polyangitis (EGPA) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Asthma</li>\n<li>Peripheral eosinophilia</li>\n<li>Allergic rhinitis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>MPO-ANCA</li>\n<li>p-ANCA pattern</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Eosinophilic granulomas</li>\n<li>Vasculitis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mixed Cryoglobulinemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Often HCV-associated</li>\n<li>Purpura</li>\n<li>Arthralgias</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Cryoglobulins</li>\n<li>HCV antibodies</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Immune complex deposits</li>\n<li>Small vessel vasculitis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 58-year-old male patient has been diagnosed with hypertension. On examination, there is no existing cardiovascular disease, no hypertension-mediated organ damage (HMOD), and renal function is normal. He should be immediately started on pharmacological management if his blood pressure is more than", "options": [{"label": "A", "text": "&amp;gt;130/80 mmHg", "correct": false}, {"label": "B", "text": "&amp;gt;160/100 mmHg", "correct": false}, {"label": "C", "text": "&amp;gt;150/100 mmHg", "correct": false}, {"label": "D", "text": "&amp;gt;140/90 mmHg", "correct": true}], "correct_answer": "D. &gt;140/90 mmHg", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - &amp;gt;140/90 mmHg</p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Systolic BP (mmHg)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Diastolic BP (mmHg)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Normal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">&lt;120</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">&lt;80</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Elevated</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">120–129</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">&lt;80</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Hypertension Stage 1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">130–139</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">80–89</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Hypertension Stage 2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">≥140</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">≥90</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Hypertensive Crisis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">&gt;180</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">&gt;120</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Indications for Use of antihypertensives</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Secondary prevention of <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> CVD events in patients with clinical CVD (defined as CHD, CHF, stroke) and BP ≥130/≥80 mmHg</li>\n<li>Primary prevention in patients with an estimated 10-year <span class=\"customMeta\" data-dictid=\"0cefa2313f1692777182f2added22a\">ASCVD</span> risk ≥10% and BP ≥130/≥80 mmHg</li>\n<li>Primary prevention of CVD and low CVD risk in patients with <strong>BP ≥140/ ≥90 mmHg</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Blood Pressure Goal in Treating Hypertension</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>BP target &lt; 130/80 mmHg for adults with confirmed <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> and known CVD or 10-year <span class=\"customMeta\" data-dictid=\"0cefa2313f1692777182f2added22a\">ASCVD</span> event risk ≥10%</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Exceptions to <span class=\"customMeta\" data-dictid=\"8dfaeedbf91692777200561b2b1d2f\">Therapeutic</span> Target of &lt;130/80 mmHg</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Age &gt;80 years</li>\n<li>Blood pressure &lt;140/90 mmHg in previously untreated <span class=\"customMeta\" data-dictid=\"dd2daa0c6216927771893c9cab82d9\">hypertensive</span> patients who experience an <span class=\"customMeta\" data-dictid=\"bef027ba821692777190cb424e9554\">ischemic stroke</span> or TIA</li>\n<li>Acute therapy for most <span class=\"customMeta\" data-dictid=\"dd2daa0c6216927771893c9cab82d9\">hypertensive</span> urgencies and emergencies</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Patient type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>First Drug</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Add a Second Drug If Needed to Achieve the target BP</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>If a Third Drug is Needed to Achieve the target BP </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Black patients (African ancestry): All ages</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">CCB or <span class=\"customMeta\" data-dictid=\"74c7df38ec169277720012966920d9\">thiazide</span> diuretic</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">ARB or <span class=\"customMeta\" data-dictid=\"677d11eaae169277718087b28f2992\">ACE</span> inhibitor</p>\n</td>\n<td colspan=\"1\" rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Combination of CCB + <span class=\"customMeta\" data-dictid=\"677d11eaae169277718087b28f2992\">ACE</span> <span class=\"customMeta\" data-dictid=\"b5fb56a28b1692777190396ae8b625\">inhibitor</span> or ARB + <span class=\"customMeta\" data-dictid=\"74c7df38ec169277720012966920d9\">thiazide</span> diuretic</p>\n<p style=\"text-align: center;\"> </p>\n<p style=\"text-align: center;\"> </p>\n<p style=\"text-align: center;\"> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">White and other non-black Patients: Younger than 60 years</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">ARB or <span class=\"customMeta\" data-dictid=\"677d11eaae169277718087b28f2992\">ACE</span> inhibitor</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">CCB or <span class=\"customMeta\" data-dictid=\"74c7df38ec169277720012966920d9\">thiazide</span> diuretic</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">White and other non-black patients: 60 years and older</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">CCB or <span class=\"customMeta\" data-dictid=\"74c7df38ec169277720012966920d9\">thiazide</span> diuretic</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">ARB or <span class=\"customMeta\" data-dictid=\"677d11eaae169277718087b28f2992\">ACE</span> inhibitor</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Hypertension with other associated conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Initial drug of choice</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hypertension and diabetes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>ARB or <span class=\"customMeta\" data-dictid=\"677d11eaae169277718087b28f2992\">ACE</span> inhibitor</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hypertension and chronic <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>ARB or <span class=\"customMeta\" data-dictid=\"677d11eaae169277718087b28f2992\">ACE</span> inhibitor</p>\n<p>Note: in black patients, good evidence for the <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> protective effects of <span class=\"customMeta\" data-dictid=\"677d11eaae169277718087b28f2992\">ACE</span> inhibitors</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hypertension and clinical <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> disease</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>β-Blocker plus ARB or <span class=\"customMeta\" data-dictid=\"677d11eaae169277718087b28f2992\">ACE</span> inhibitor</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hypertension and stroke history</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>ARB or <span class=\"customMeta\" data-dictid=\"677d11eaae169277718087b28f2992\">ACE</span> inhibitor</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hypertension and heart failure</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Regardless of blood pressure, ARB or <span class=\"customMeta\" data-dictid=\"677d11eaae169277718087b28f2992\">ACE</span> <span class=\"customMeta\" data-dictid=\"b5fb56a28b1692777190396ae8b625\">inhibitor</span> + β-blocker + <span class=\"customMeta\" data-dictid=\"82987dba8b16927771861f93f6d325\">diuretic</span> + spironolactone. A dihydropyridine CCB can be added if needed for BP control.</p>\n<p>Pneumonic: ABDS</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A lesion at which level produces incongruous homonymous hemianopia with Wernicke's pupil?", "options": [{"label": "A", "text": "Optic tract", "correct": true}, {"label": "B", "text": "Visual cortex", "correct": false}, {"label": "C", "text": "Optic radiation", "correct": false}, {"label": "D", "text": "Optic nerve", "correct": false}], "correct_answer": "A. Optic tract", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - &lt;span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\"&gt;Optic&lt;/span&g\n<p><strong>References:</strong></p>\n<ul><li>↳ Reference:</li></u\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What should be the next course of action in managing a 50-year-old patient who has a medical history of hypertension and diabetes mellitus, and is currently presenting with a feeble pulse and a blood pressure reading of 90/40 mm Hg?", "options": [{"label": "A", "text": "IV adenosine", "correct": false}, {"label": "B", "text": "IV diltiazem", "correct": false}, {"label": "C", "text": "DC cardioversion", "correct": true}, {"label": "D", "text": "Ibutilide", "correct": false}], "correct_answer": "C. DC cardioversion", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/CkjcNGAk5zcQMpSpqbME1746453858.png"], "explanation": "<p>Correct Option C) DC &lt;span class=\"customMeta\" data-dictid=\"f6c133a4ba1692777183c42bc77b81\"&gt;cardioversion&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient came to the hospital with complaints of lethargy, increased sleep, and weight gain. Investigations revealed low plasma TSH concentration. However, on the administration of TRH, the TSH levels increased. Which of the conditions is likely in this patient?", "options": [{"label": "A", "text": "Hyperthyroidism due to disease in the pituitary", "correct": false}, {"label": "B", "text": "Hypothyroidism due to disease in the pituitary", "correct": false}, {"label": "C", "text": "Hypothyroidism due to disease in the hypothalamus", "correct": true}, {"label": "D", "text": "Hyperthyroidism due to disease in the hypothalamus", "correct": false}], "correct_answer": "C. Hypothyroidism due to disease in the hypothalamus", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:721px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Primary Hypothyroidism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Secondary Hypothyroidism</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Thyroid <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> leads to inadequate <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> hormone production</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pituitary <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> leads to insufficient <span class=\"customMeta\" data-dictid=\"e33d6cd73e1692777200667a6d2703\">TSH</span> secretion</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Autoimmune (Hashimoto's thyroiditis)</li>\n<li>Iatrogenic (e.g., post-thyroidectomy, radiation)</li>\n<li>Iodine deficiency</li>\n<li>Medications (e.g., amiodarone, lithium)</li>\n<li>Infiltrative diseases (e.g., sarcoidosis)</li>\n<li>Food <span class=\"customMeta\" data-dictid=\"30e693d8521692777188a5ea13201b\">goitrogen</span> → Cabbage, cassava.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pituitary tumors</li>\n<li>Pituitary surgery or radiation</li>\n<li>Sheehan’s syndrome</li>\n<li>Trauma</li>\n<li>Genetic <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> hormone deficiencies</li>\n<li>Non-obstetric cause of <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> damage called Simmonds's disease (AVM, tumor, HTN)</li>\n<li>Sarcoidosis</li>\n<li>Hemochromatosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lab</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>TSH - ↑</strong></p>\n<p>Free T3/T4 - ↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>TSH - Normal or ↓</strong></p>\n<p>Free T3/T4 - ↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Fatigue, weight gain</strong>, cold intolerance</li>\n<li>Dry skin, hair loss</li>\n<li><strong>Increased sleep</strong></li>\n<li>Bradycardia, constipation</li>\n<li>Myxedema (puffy face, non-pitting edema)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Similar to primary hypothyroidism</li>\n<li>Other <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> hormone deficiencies (e.g., low cortisol, low LH/FSH)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Levothyroxine (T4) replacement with <span class=\"customMeta\" data-dictid=\"b5bd69c9791692777186a40f45ffb6\">dosage</span> based on <span class=\"customMeta\" data-dictid=\"e33d6cd73e1692777200667a6d2703\">TSH</span> levels</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Levothyroxine (T4) replacement, but monitored by free T4 levels (since <span class=\"customMeta\" data-dictid=\"e33d6cd73e1692777200667a6d2703\">TSH</span> is unreliable)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An elderly woman is brought to the OPD with complaints of behavioural change, a history of multiple falls, urinary incontinence, and dementia. What is your diagnosis?", "options": [{"label": "A", "text": "Normal pressure hydrocephalus", "correct": true}, {"label": "B", "text": "Frontotemporal dementia", "correct": false}, {"label": "C", "text": "Parkinson disease", "correct": false}, {"label": "D", "text": "Creutzfeldt-Jakob disease", "correct": false}], "correct_answer": "A. Normal pressure hydrocephalus", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/3Nd8qB4wUvIkblqvyu4o1746510398.png", "https://image.prepladder.com/content/psCfZn4gMasHySOuhbOS1746510398.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:710px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Normal Pressure <span class=\"customMeta\" data-dictid=\"018823377416927771896f6aa736a4\">Hydrocephalus</span> (NPH)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>NPH is often <span class=\"customMeta\" data-dictid=\"4acddc3cf5169277718996440e2e14\">idiopathic</span> but can result from prior injuries affecting <span class=\"customMeta\" data-dictid=\"99a9bf133e1692777184ec4b1011fe\">cerebrospinal</span> fluid (CSF) dynamics, such as <span class=\"customMeta\" data-dictid=\"0a5d82eeef169277719934b86fb07b\">subarachnoid</span> hemorrhage.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Triad</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Gait disturbance</strong>: Progressive difficulties in walking</li>\n<li><strong>Urinary issues</strong>: Urgency or incontinence</li>\n<li><strong>Cognitive impairment</strong>: Decline in cognitive functions</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Imaging Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Ventriculomegaly is typically seen</li>\n<li><strong>Evans ratio</strong>: the ratio of the maximum <span class=\"customMeta\" data-dictid=\"1b0d31fe811692777202644090ba60\">width</span> of <span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\">frontal</span> horns to inner table <span class=\"customMeta\" data-dictid=\"1b0d31fe811692777202644090ba60\">width</span> of <strong>more than 0.31 </strong>is often used for evaluation but has low <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> accuracy.</li>\n<li>An <strong>acute <span class=\"customMeta\" data-dictid=\"3d75814381169277718350f5548cc1\">callosal</span> angle </strong>(less than 90°) on <span class=\"customMeta\" data-dictid=\"dad5b2152216927771851a3d10cd41\">coronal</span> MR images is another measurement used, also with limited accuracy.</li>\n<li>A<strong> disproportionately enlarged <span class=\"customMeta\" data-dictid=\"0a5d82eeef169277719934b86fb07b\">subarachnoid</span> space hydrocephalus</strong> is seen having <span class=\"customMeta\" data-dictid=\"8501c4040a1692777201eb9e7ea8f6\">ventriculomegaly</span> combined with sulcal <span class=\"customMeta\" data-dictid=\"dc0035cd191692777187b9b8b2af69\">effacement</span> at the <span class=\"customMeta\" data-dictid=\"47effe8b551692777201331142edf5\">vertex</span> and scattered enlarged sulci.</li>\n<li>CSF flow study shows hyper-dynamism with a streak of flow <span class=\"customMeta\" data-dictid=\"3ea4fc34801692777202b98af71861\">void</span> through cerebral aqueduct.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is a bioterrorism Category A agent?", "options": [{"label": "A", "text": "Nipah virus", "correct": false}, {"label": "B", "text": "Anthrax", "correct": true}, {"label": "C", "text": "Coxiella", "correct": false}, {"label": "D", "text": "Brucella", "correct": false}], "correct_answer": "B. Anthrax", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Category A</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Category B</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Category C</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Priority</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High-priority agents posing a risk to national security</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Second highest priority</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Third highest priority with emerging pathogens</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>The reason they are classified into the respective categories:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Easily <span class=\"customMeta\" data-dictid=\"f4006059f916927771865569d4da7d\">disseminated</span> in the environment</li>\n<li>High mortality risk</li>\n<li>Cause public panic and social disruption</li>\n<li>Requires special action for <span class=\"customMeta\" data-dictid=\"f42f73407916927771969cb688f953\">public health</span> preparedness</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Moderately easy to disseminate.</li>\n<li>Moderate <span class=\"customMeta\" data-dictid=\"9b7604d5461692777192546af7cabd\">morbidity</span> risk.</li>\n<li>Requires enhanced disease surveillance.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It can be engineered for mass dissemination in the future.</li>\n<li>It has the potential for high mortality and morbidity.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Examples:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Bacillus anthracis - <span class=\"customMeta\" data-dictid=\"00f05eda23169277718196fcb2f71f\">Anthrax</span> <strong>(Option B)</strong></li>\n<li>Francisella tularensis - Tularemia</li>\n<li>Clostridium botulinum - Botulism</li>\n<li>Yersinia <span class=\"customMeta\" data-dictid=\"1db39f708f16927771954d003af865\">pestis</span> - Bubonic plague</li>\n<li>Ebola virus - Ebola hemorrhagic fever</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Clostridium perfringens - <span class=\"customMeta\" data-dictid=\"101f5ea2741692777187173286abbb\">epsilon</span> toxin.</li>\n<li>Cryptosporidium parvum.</li>\n<li>Escherichia <span class=\"customMeta\" data-dictid=\"cd0a7121a516927771846d8f5248bb\">coli</span> (O157:H7)</li>\n<li>Shigella dysenteriae.</li>\n<li>Salmonella.</li>\n<li>Vibrio cholera.</li>\n<li>Coxiella burnetii <strong>(Option C ruled out)</strong></li>\n<li>Brucella <strong>(Option D ruled out)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hantavirus</li>\n<li>MDR-tuberculosis</li>\n<li>Nipah Virus <strong>(Option A ruled out)</strong></li>\n<li>Yellow fever</li>\n<li>Tick-borne <span class=\"customMeta\" data-dictid=\"9644652a1f16927771873765457fcc\">encephalitis</span> /hemorrhagic fever</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is seen in pituitary apoplexy?", "options": [{"label": "A", "text": "Hypertension", "correct": false}, {"label": "B", "text": "Shock", "correct": true}, {"label": "C", "text": "Unconsciousness", "correct": false}, {"label": "D", "text": "Fatigue", "correct": false}], "correct_answer": "B. Shock", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Pituitary <span class=\"customMeta\" data-dictid=\"ceceecabdc16927771816d3965c74f\">apoplexy</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Acute intra-pituitary <span class=\"customMeta\" data-dictid=\"4642acfc0c16927771880b34fa5174\">hemorrhage</span> resulting in an <span class=\"customMeta\" data-dictid=\"d8216cf7571692777187baa94b8612\">endocrine</span> emergency</li>\n<li>It may arise spontaneously in preexisting adenomas, occur <span class=\"customMeta\" data-dictid=\"3d885759d516927771966b84bfa470\">postpartum</span> or be associated with conditions like diabetes, hypertension, sickle cell anemia, or<strong> <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> shock.</strong></li>\n<li><strong>Severe ↓ <span class=\"customMeta\" data-dictid=\"55fd11666f1692777180e80135bda8\">ACTH</span> and GH, other hormones may be ↓ or normal</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Severe headache</li>\n<li>Central nervous system (CNS) hemorrhage</li>\n<li>Signs of meningeal irritation</li>\n<li><strong>Loss of consciousness</strong> (secondary to <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> <span class=\"customMeta\" data-dictid=\"80feaae4b31692777190ea1ba3fc25\">insufficiency</span> and shock) <strong>(Option C)</strong></li>\n<li>Bilateral visual changes</li>\n<li>Ophthalmoplegia (eye muscle paralysis)</li>\n<li>Hypoglycemia</li>\n<li><strong>Hypotension (Option A)</strong></li>\n<li><strong>Shock</strong></li>\n<li>Cardiovascular collapse</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>High-dose glucocorticoids</strong> are the first line of treatment to correct <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> insufficiency, stabilize blood pressure, and correct hypoglycemia.</li>\n<li>Patients without evident visual loss or impaired consciousness can be managed conservatively with high-dose glucocorticoids.</li>\n<li><strong>Urgent <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> decompression: </strong>Required for patients with significant or progressive visual loss, <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> nerve palsy, or loss of consciousness.</li>\n<li><strong>Monitoring: </strong>Visual recovery is inversely correlated with the duration of time after the <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> event, so timely intervention is crucial.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 5-year-old boy presents with low-grade fever, inspiratory stridor, and a barking cough for 5 days. Chest X-ray findings suggest the diagnosis. What is the causative agent?", "options": [{"label": "A", "text": "Moraxella", "correct": false}, {"label": "B", "text": "Parainfluenza", "correct": true}, {"label": "C", "text": "Ebola virus", "correct": false}, {"label": "D", "text": "Staphylococcus aureus", "correct": false}], "correct_answer": "B. Parainfluenza", "question_images": ["https://image.prepladder.com/content/eWES8wj661azTqeyCxJ41746510528.png"], "explanation_images": ["https://image.prepladder.com/content/76FW7FaBVz1IkaA8tSpG1746510629.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Laryngotracheobronchitis (Croup)</strong></p>\n<p>Refers to <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> infection of the glottic and <span class=\"customMeta\" data-dictid=\"b83a5450d216927771990efacefc4c\">subglottic</span> regions.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causative Agent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Parainfluenza viruses (types 1,2 and 3) cause about 75% cases.</li>\n<li>Other Viruses:\n\t\t\t\t<ul>\n<li>Influenza A and B,</li>\n<li>Adenovirus,</li>\n<li>Respiratory syncytial virus,</li>\n<li>Measles.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age Group</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Most common in children aged 3 months to 5 years.</li>\n<li>Peak <span class=\"customMeta\" data-dictid=\"17cd3771bb1692777190950c142dbe\">incidence</span> occurs in the 2nd year of life.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Initial Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>These symptoms last 1-3 days before development of upper <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> signs and symptoms.</p>\n<ul>\n<li>Upper <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infection</li>\n<li>Rhinorrhea,</li>\n<li>Pharyngitis,</li>\n<li>Mild cough,</li>\n<li>Low-grade fever.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Progressive Symptoms </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Barking cough,</li>\n<li>Hoarseness,</li>\n<li>Inspiratory stridor,</li>\n<li>Fever may reach 39-40°C (102.2-104°F) or be absent.</li>\n<li>The child prefers to sit up in bed or be held upright.</li>\n<li>Symptoms worsen at night, recur over days and resolve within a week.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Physical Examination Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hoarse voice,</li>\n<li>Coryza,</li>\n<li>Normal to moderately inflamed pharynx.</li>\n<li>Slightly increased <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> rate.</li>\n<li>Hypoxia and low <span class=\"customMeta\" data-dictid=\"b98c3a8ea216927771949889d9505f\">oxygen saturation</span> seen only in complete <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> obstruction.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Clinical diagnosis</li>\n<li>X-ray PA view of neck: <strong>Steeple sign, </strong>which is characteristic of <span class=\"customMeta\" data-dictid=\"b83a5450d216927771990efacefc4c\">subglottic</span> narrowing</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Frank Gaillard,\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Steeple_sign#/media/File:Croup_steeple_sign.jpg\" data-tags=\"\" height=\"488\" src=\"https://image.prepladder.com/content/76FW7FaBVz1IkaA8tSpG1746510629.png\" width=\"600\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Mainstay of Treatment:</strong> Focus on <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> management and <span class=\"customMeta\" data-dictid=\"a249eeb5551692777189661d39c1b2\">hypoxia</span> treatment.</li>\n<li><strong>Mild croup: </strong>Single dose dexamethasone.</li>\n<li><strong>Moderate to severe croup: </strong>Nebulized <span class=\"customMeta\" data-dictid=\"76baf6616a169277718738f8790ab9\">epinephrine</span> in addition to dexamethasone.</li>\n<li><strong>Nebulized Racemic Epinephrine: </strong>Used for moderate to severe <span class=\"customMeta\" data-dictid=\"c8af142f48169277719965c593fa0b\">stridor</span> at rest, possible need for intubation, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"afafb9026e1692777186e3dd168fa8\">distress</span> and hypoxia.</li>\n<li><strong>Corticosteroids:</strong>\n<ul>\n<li>Decrease <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> in laryngeal mucosa</li>\n<li>Oral steroids beneficial in mild croup</li>\n<li>Dexamethasone 0.6 mg/kg single dose; as low as 0.15 mg/kg may be effective.</li>\n</ul>\n</li>\n<li>Antibiotics are not indicated.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable diagnosis for a 60-year-old man who is grieving the loss of his wife and expressing guilt, believing his intestines have deteriorated and that he deserves to be imprisoned? He also reports persistent sadness and a lack of interest in daily activities since his wife's passing.", "options": [{"label": "A", "text": "Normal grief reaction", "correct": false}, {"label": "B", "text": "Psychotic depression", "correct": true}, {"label": "C", "text": "Delusional disorder", "correct": false}, {"label": "D", "text": "Schizophrenia", "correct": false}], "correct_answer": "B. Psychotic depression", "question_images": [], "explanation_images": [], "explanation": "<table align=\"left\" cellspacing=\"0\" style=\"border-collapse:collapse; width:674px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Psychotic depression</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Major depression disorder (MDD) with <span class=\"customMeta\" data-dictid=\"23702653681692777196e5c0fc63cd\">psychotic</span> features includes mood <span class=\"customMeta\" data-dictid=\"4586eccbe71692777186e577e31829\">disturbance</span> with delusions, hallucinations, or both.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prevalence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Occurs in approximately 18.5% of MDD patients and increases with age.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Higher treatment resistance</li>\n<li>More suicide attempts</li>\n<li>Longer illness duration</li>\n<li>Greater functional impairment</li>\n<li>Higher <span class=\"customMeta\" data-dictid=\"b4b361c37616927771979541177070\">relapse</span> rates</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Older patients may exhibit more brain <span class=\"customMeta\" data-dictid=\"97ff5253fb169277718224c7b0faf8\">atrophy</span> and higher mortality rates compared to non-psychotic patients.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Geriatric Considerations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Patients often show significant cognitive dysfunction; <span class=\"customMeta\" data-dictid=\"f6e39eb41116927771865b34e2ec08\">depressive pseudodementia</span> may develop.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cognitive Impairment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Combination therapy</strong>: <strong>antidepressants </strong>+ <strong>antipsychotics </strong>or <strong>ECT </strong>is the standard of care.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment Approaches</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Monotherapy </strong>with <strong>SSRIs </strong>or <strong>TCAs </strong>is <strong>less effective</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Efficacy of ECT</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>ECT shows high <span class=\"customMeta\" data-dictid=\"b4a3b8da7716927771975375dadad9\">remission</span> rates (up to 95% in <span class=\"customMeta\" data-dictid=\"23702653681692777196e5c0fc63cd\">psychotic</span> depression) compared to pharmacotherapy.</li>\n<li><strong>ECT is first line treatment in case of severe <span class=\"customMeta\" data-dictid=\"23702653681692777196e5c0fc63cd\">psychotic</span> symptoms and high suicide risk.</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 20-year-old man presents to the emergency department with respiratory distress and hypotension following a trauma. He has subcutaneous emphysema, and there is an absence of air entry into the right side of the lungs. What is the next best step?", "options": [{"label": "A", "text": "Start IV fluids with a large bore cannula", "correct": false}, {"label": "B", "text": "Needle decompression into the 5 th intercostal space anterior to the midaxillary line", "correct": true}, {"label": "C", "text": "Take the patient to the ICU and intubate him", "correct": false}, {"label": "D", "text": "Start positive pressure ventilation", "correct": false}], "correct_answer": "B. Needle decompression into the 5 th intercostal space anterior to the midaxillary line", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/VXrt8qJsOCJ5wHRA1a361746510689.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:719px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>TENSION PNEUMOTHORAX</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>D/t ‘one-way valve’ air leaks from the lung or chest wall.</li>\n<li>Air is sucked into the <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> without any escape, collapsing and compressing the affected lung.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"be2aea1ed01692777192b46ee482a3\">mediastinum</span> shifts to the opposite side, reducing <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> return and compressing the opposite lung, leading to decreased <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> output and function. This can result in sudden death.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>Penetrating Chest Trauma.</strong></li>\n<li><strong>Blunt Chest Trauma </strong>with parenchymal lung injury and persistent air leak.</li>\n<li>Iatrogenic Lung Injury (e.g., central venepuncture)</li>\n<li>Mechanical Positive-Pressure Ventilation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>Tachypnea and Tachycardia</strong></li>\n<li>Hyper-resonance and <strong>Decreased/Absent Breath Sounds</strong></li>\n<li>Resonant <span class=\"customMeta\" data-dictid=\"4818bebdf31692777195cc835c12d4\">Percussion</span> with severe mediastinal/tracheal shift</li>\n<li>Cyanosis and Hypotension</li>\n<li>Chest Pain</li>\n<li>Distended Neck Veins</li>\n<li><strong>Subcutaneous <span class=\"customMeta\" data-dictid=\"279b1fbead1692777187ddfd24c257\">emphysema</span> </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Emergency Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Tension <span class=\"customMeta\" data-dictid=\"d9d1e6f2801692777196f37b28fb6a\">pneumothorax</span> is a clinical diagnosis, and treatment should never be delayed by waiting for radiological confirmation.</li>\n<li><strong>Immediate <span class=\"customMeta\" data-dictid=\"367e80b0381692777200c1327c5238\">Thoracocentesis</span> (needle): Wide bore needle (typically a 20- or 22-gauge) in the 5th <span class=\"customMeta\" data-dictid=\"73796a0ae81692777190a4306a66a3\">intercostal</span> space in the safety triangle.</strong></li>\n<li>Decompression should be performed in the \"safe triangle.\"\n\t\t\t\t<ul>\n<li><strong>Safe <span class=\"customMeta\" data-dictid=\"d398f22bb71692777201622867bda7\">Triangle</span> Boundaries</strong>:\n\t\t\t\t\t<ul>\n<li>Posterior: <span class=\"customMeta\" data-dictid=\"12ad4210e4169277719111f356b7ba\">Latissimus</span> dorsi</li>\n<li>Anterior: <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> border of the <span class=\"customMeta\" data-dictid=\"afa97794e21692777195a324ffec49\">pectoralis</span> major</li>\n<li>Inferior: A line drawn perpendicularly from the <span class=\"customMeta\" data-dictid=\"9fdffd913216927771936512ee5b2a\">nipple</span> to the back, just <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> to the mid-axillary line.</li>\n</ul>\n</li>\n</ul>\n</li>\n</ul>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"586\" src=\"https://image.prepladder.com/content/VXrt8qJsOCJ5wHRA1a361746510689.png\" width=\"588\"/></p>\n<ul>\n<li>In critical situations, a finger <span class=\"customMeta\" data-dictid=\"0e733c2a0916927772001a6cd08d35\">thoracostomy</span> can be done in the same location.</li>\n<li>Nasal Oxygen for support.</li>\n<li>Intercostal Tube Placement (ICT) once stable and confirmed by chest X-ray.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Additional Care </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Antibiotics and analgesics for treatment.</li>\n<li>Ventilator Support with IPPV in severe cases.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the preferred treatment option for postpartum blues?", "options": [{"label": "A", "text": "Fluoxetine", "correct": false}, {"label": "B", "text": "Cognitive behavioural therapy", "correct": false}, {"label": "C", "text": "Lithium carbonate", "correct": false}, {"label": "D", "text": "Support and Education", "correct": true}], "correct_answer": "D. Support and Education", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:773px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Postpartum Blues</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Postpartum Depression </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Postpartum Psychosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Occurrence </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It affects <strong>up to 80%</strong> of women <strong>after childbirth</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>It affects <strong>10 - 15%</strong> of women</li>\n<li>70% risk of <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> in the next pregnancy</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Incidence is about <strong>1-2</strong> in 1000 deliveries</li>\n<li>50% risk of <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> in the next pregnancy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Timing </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Onset 3-5 days postpartum, resolves by days to weeks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Within the first 6 weeks <span class=\"customMeta\" data-dictid=\"3d885759d516927771966b84bfa470\">postpartum</span> or after abortion</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Symptoms appear within 2-3 weeks <span class=\"customMeta\" data-dictid=\"3d885759d516927771966b84bfa470\">postpartum</span> and last 2-3 months.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Symptoms </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Transient symptoms such as</p>\n<ul>\n<li>Emotionally labile</li>\n<li>Insomnia</li>\n<li>Weepiness</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Loss of energy</li>\n<li>Depressed mood</li>\n<li>Loss of interest or pleasure (anhedonia)</li>\n<li>Loss of appetite</li>\n<li>Insomnia</li>\n<li>Social withdrawal</li>\n<li>Irritability</li>\n<li>Suicidal thoughts</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Initial symptoms: insomnia, tearfulness, mood lability, fatigue, followed by</p>\n<ul>\n<li>Hallucinations</li>\n<li>Delusions</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Supportive treatment and reassurance</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Antidepressants and psychotherapy</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hospitalization, pharmacological treatment (lithium, antipsychotics, antidepressants), long-term psychiatric care</li>\n<li>Temporary separation from the infant and <span class=\"customMeta\" data-dictid=\"6f686e0c91169277719346f95361c8\">nursing</span> supervision may be necessary</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following helps in bacterial adhesion?", "options": [{"label": "A", "text": "Cytoplasmic membrane", "correct": false}, {"label": "B", "text": "Mesosomes", "correct": false}, {"label": "C", "text": "Fimbriae", "correct": true}, {"label": "D", "text": "Lipopolysaccharides", "correct": false}], "correct_answer": "C. Fimbriae", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Mj6LfC9djrH3mBwCl7SH1746510772.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fimbriae are thin, hair-like appendages found on the surface of many bacteria, primarily <span class=\"customMeta\" data-dictid=\"08cb2b02c81692777188b83845c84c\">Gram-negative</span> bacteria.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Structure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fimbriae are composed of protein subunits called pilins<strong>.</strong> They are usually shorter and more numerous than flagella.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Common (Type I) Fimbriae:</strong> <span class=\"customMeta\" data-dictid=\"396cb274df16927771803e151a1109\">Adhesive</span> fimbriae that bind to mannose-containing receptors on host cells.</li>\n<li><strong>Sex Pili:</strong> Involved in bacterial <span class=\"customMeta\" data-dictid=\"5bf9387ee91692777185685e187e76\">conjugation</span> and DNA transfer.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Functions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Adhesion:</strong> Fimbriae allow bacteria to adhere to surfaces, cells, and tissues, which is crucial for <span class=\"customMeta\" data-dictid=\"d9e023242c16927771840efda08ae3\">colonization</span> and infection.</li>\n<li><strong>Biofilm Formation:</strong> Contribute to <span class=\"customMeta\" data-dictid=\"dde6d4ec8216927771835986a542e1\">biofilm</span> formation, protecting bacteria from environmental stresses.</li>\n<li><strong>Gene Transfer:</strong> Sex pili facilitates the transfer of genetic material between bacteria during conjugation, promoting genetic diversity and the spread of <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> resistance.</li>\n<li><strong>Motility:</strong> Usually not involved except <span class=\"customMeta\" data-dictid=\"4019d01072169277720163b0f7ec43\">Type IV</span> Pili, particularly in <span class=\"customMeta\" data-dictid=\"a3acbdadb41692777193612b704230\">Neisseria</span> species, enabling a type of movement known as <span class=\"customMeta\" data-dictid=\"90e9d2db7f1692777201d0a9b101c5\">twitching</span> motility.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Uses in Medicine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Target for Vaccines:</strong> Components of fimbriae can be used as antigens in vaccines to prevent bacterial infections.</li>\n<li><strong>Antimicrobial Targets:</strong> Inhibiting fimbrial function can prevent bacterial <span class=\"customMeta\" data-dictid=\"2b1931a185169277718065e3fa42dd\">adhesion</span> and <span class=\"customMeta\" data-dictid=\"dde6d4ec8216927771835986a542e1\">biofilm</span> formation, making it a potential target for new antibiotics.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Importance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Urinary <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">Tract</span> Infections (UTIs): </strong>Uropathogenic E. <span class=\"customMeta\" data-dictid=\"cd0a7121a516927771846d8f5248bb\">coli</span> (UPEC) use <span class=\"customMeta\" data-dictid=\"ebcb7136251692777201ef4b5c5718\">Type 1</span> fimbriae to adhere to the <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> tract, causing UTIs.</li>\n<li><strong>Respiratory Infections:</strong> Bacteria like <span class=\"customMeta\" data-dictid=\"69e1e04b2d16927771837675e4a49f\">Bordetella</span> <span class=\"customMeta\" data-dictid=\"e407b4ecb9169277719549831239bb\">pertussis</span> (whooping cough) use fimbriae to adhere to the <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> tract.</li>\n<li><strong>Gastrointestinal Infections:</strong> <span class=\"customMeta\" data-dictid=\"ddfb3dbb6016927771870b4ad78fed\">Enteropathogenic</span> E. <span class=\"customMeta\" data-dictid=\"cd0a7121a516927771846d8f5248bb\">coli</span> (EPEC) use fimbriae to adhere to the intestinal mucosa, causing diarrhea.</li>\n<li><strong>Pseudomonas aeruginosa</strong>: Uses <span class=\"customMeta\" data-dictid=\"4019d01072169277720163b0f7ec43\">Type IV</span> pili for surface <span class=\"customMeta\" data-dictid=\"ccd357daaf16927771825777ea6a0d\">attachment</span> and <span class=\"customMeta\" data-dictid=\"dde6d4ec8216927771835986a542e1\">biofilm</span> formation.</li>\n<li><strong>Neisseria gonorrhoeae:</strong> Uses fimbriae for <span class=\"customMeta\" data-dictid=\"ccd357daaf16927771825777ea6a0d\">attachment</span> to mucosal surfaces in the <span class=\"customMeta\" data-dictid=\"2fd33fb2ac16927771889901daadeb\">genitourinary</span> tract.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Laboratory Identification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Hemagglutination Assay: </strong>Detects <span class=\"customMeta\" data-dictid=\"ebcb7136251692777201ef4b5c5718\">Type 1</span> fimbriae by their ability to agglutinate red blood cells.</li>\n<li><strong>Electron Microscopy:</strong> Visualizes fimbriae on the surface of bacteria.</li>\n<li><strong>Pellicle Formation</strong>: Observing <span class=\"customMeta\" data-dictid=\"324cdf6113169277719503050d8593\">pellicle</span> formation on liquid culture surfaces can indicate the presence of fimbriae.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Please determine the sleep stage based on the red-highlighted EEG findings.", "options": [{"label": "A", "text": "Stage 1", "correct": false}, {"label": "B", "text": "Stage 2", "correct": false}, {"label": "C", "text": "Stage 3", "correct": false}, {"label": "D", "text": "Stage 4", "correct": true}], "correct_answer": "D. Stage 4", "question_images": ["https://image.prepladder.com/content/5PBPBsCdfK0LBcjP4xdq1746510865.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:632px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>EEG</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Awake (Stage W)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Alpha waves (8-13 Hz) with eyes closed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>N1 Stage (Light Sleep) </strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Loss of <span class=\"customMeta\" data-dictid=\"a9268f2e1d16927771814cfef69cf4\">alpha</span> waves, <span class=\"customMeta\" data-dictid=\"ccb50023dc1692777200804b8475ca\">theta</span> waves (4-7 Hz)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>N2 Stage (Moderate Sleep)</strong></p>\n<p><strong>(Option B ruled out) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Sleep spindles (12-14 Hz), K complexes</strong> (sharp negative followed by positive waves)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>N3 Stage (Deep Sleep)</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Delta waves (slow, high amplitude)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>N4 Stage </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>It largely overlaps with Stage 3 in terms of characteristics. Predominantly <span class=\"customMeta\" data-dictid=\"f7d3133242169277718518c059ad55\">delta</span> waves (low-frequency, high-amplitude brain waves) indicate very deep sleep.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old female from a tribal area presents with fever for the last 3 days. A peripheral smear confirms the diagnosis of malaria. Which of the following is the most likely causative agent?", "options": [{"label": "A", "text": "Plasmodium falciparum", "correct": true}, {"label": "B", "text": "Plasmodium malariae", "correct": false}, {"label": "C", "text": "Plasmodium ovale", "correct": false}, {"label": "D", "text": "Plasmodium vivax", "correct": false}], "correct_answer": "A. Plasmodium falciparum", "question_images": ["https://image.prepladder.com/content/GYj5BjWVJDsLwvNgUXvC1746510934.png"], "explanation_images": ["https://image.prepladder.com/content/IP7xBefTNFcHbrkVqa0z1746511051.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Vivax </strong></p>\n<p style=\"text-align:center\"><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Falciparum </strong></p>\n<p style=\"text-align:center\"><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Malariae </strong></p>\n<p style=\"text-align:center\"><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Ovale </strong></p>\n<p style=\"text-align:center\"><strong>(Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>RBC size </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Enlarged</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Enlarged with frayed margins</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pigments </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Yellowish brown</p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Dark brown</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Schizont </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Large (9-10 μm)</p>\n<p>Fills the RBC</p>\n<p>Contains 12-24 merozoite</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Not seen in the periphery</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Small (6 μm), almost fills the RBC and contains 8 merozoites</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gametocytes </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Spherical</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Crescentic</p>\n<p>Larger than RBC</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Spherical</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ring <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2.5 μm</p>\n<p>Occupies ⅓ rd of RBC size</p>\n<p>Cytosol opposite to the <span class=\"customMeta\" data-dictid=\"ff628904401692777193c8a9f9159e\">nucleus</span> is thick</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1.5 μm</p>\n<p>Occupies ⅙ of RBC size</p>\n<p>It may be</p>\n<ul>\n<li>Multiple forms</li>\n<li>Accole (attached to RBC membrane)</li>\n<li>Double dot/headphone shaped with fragment nucleus</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Band form</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2.5 μm</p>\n<p>Occupies ⅓ rd of RBC size</p>\n<p>Cytosol opposite to the <span class=\"customMeta\" data-dictid=\"ff628904401692777193c8a9f9159e\">nucleus</span> is thick</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>In Plasmodium falciparum, only <span class=\"customMeta\" data-dictid=\"36514f2a4416927771881b27e74758\">gametocyte</span> and ring forms are demonstrated in the PBS, as later stages of the <span class=\"customMeta\" data-dictid=\"7d53fd92541692777187195e87ab70\">erythrocytic</span> cycle occur in deep vessels and not in <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> blood.</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Malaria</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Agent</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Plasmodium species</strong></p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Species</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Fever Cycle</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>P.falciparum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Malignant Tertian Malaria</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Every 48 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>P.vivax</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Benign Tertian Malaria</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Every 48 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>P.malariae</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Quartan Malaria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Every 72 hours</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>P.ovale</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ovale Malaria</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Every 48 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>P. knowlesi</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Quotidian Malaria</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Every 24 hours (daily)</p>\n</td>\n</tr>\n</tbody>\n</table>\n\t\t\t \n\n\t\t\t<p>Incubation Period: 7-30 days, depending on Plasmodium species</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vector</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Female Anopheles mosquitoes</p>\n<ul>\n<li><strong>Behavior: Nocturnal feeders; </strong>prefer to bite between dusk and dawn</li>\n<li>Breeding Sites: Stagnant water bodies such as ponds, marshes, swamps, and artificial containers</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Transmission</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Bites of infected female Anopheles mosquitoes</li>\n<li><strong>Can be transmitted through blood transfusions and organ transplants.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Host</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Humans (Primary Host)\n\t\t\t\t<ul>\n<li>Higher risk in pregnant women, infants, and immunocompromised</li>\n</ul>\n</li>\n<li>Anopheles mosquitoes (Vector and Intermediate host)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Environmental Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Climate: Warm and Humid environment</li>\n<li>Seasonality: Rainy seasons</li>\n<li>Geographical Distribution:\n\t\t\t\t<ul>\n<li><strong>Most prevalent in tropical and subtropical regions</strong></li>\n<li>India: Endemic in several states, particularly in the northeastern states (Assam, Tripura, Meghalaya), Eastern states (Odisha, Jharkhand), and some parts of Maharashtra and Karnataka</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Species</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Fever Cycle</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>P.falciparum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Malignant Tertian Malaria</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Every 48 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>P.vivax</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Benign Tertian Malaria</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Every 48 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>P.malariae</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Quartan Malaria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Every 72 hours</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>P.ovale</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ovale Malaria</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Every 48 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>P. knowlesi</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Quotidian Malaria</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Every 24 hours (daily)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What antenatal complication can be anticipated in the mother of the first baby, considering the second baby is a healthy newborn?", "options": [{"label": "A", "text": "Intake of Phenytoin", "correct": false}, {"label": "B", "text": "Gestational diabetes", "correct": true}, {"label": "C", "text": "Intake of ACE inhibitors", "correct": false}, {"label": "D", "text": "Intake of sodium valproate", "correct": false}], "correct_answer": "B. Gestational diabetes", "question_images": ["https://image.prepladder.com/content/Td7weyA2rYVPTSkUmIGa1746511089.png"], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:613px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Complication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Macrosomia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Large birth weight of the baby (over 4,000 grams or 8 pounds 13 ounces), which can increase delivery complications.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Shoulder dystocia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Difficulty delivering the baby's shoulders after the head is delivered, which can lead to birth injuries and complications.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Neonatal hypoglycemia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low <span class=\"customMeta\" data-dictid=\"88b48cf7241692777183e5f5b8adf1\">blood sugar</span> levels in the <span class=\"customMeta\" data-dictid=\"04df903fe8169277719383126b1b02\">newborn</span> due to elevated <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> levels during pregnancy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Preterm birth</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Delivery of the baby before 37 weeks of gestation, which increases the risk of health problems for the baby.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Respiratory <span class=\"customMeta\" data-dictid=\"afafb9026e1692777186e3dd168fa8\">distress</span> syndrome (RDS)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A breathing disorder in <span class=\"customMeta\" data-dictid=\"84f13673191692777196762b18e036\">premature</span> babies due to <span class=\"customMeta\" data-dictid=\"c219021c491692777189d289f1fc03\">immature</span> lungs.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Jaundice</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A yellowing of the baby's skin and eyes caused by high <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> levels.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Preeclampsia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High <span class=\"customMeta\" data-dictid=\"263ee5444e1692777183a7e8e704da\">blood pressure</span> and organ damage in the mother during pregnancy.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Type 2 diabetes later in life</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased risk of developing <span class=\"customMeta\" data-dictid=\"05e8c1df0d1692777201c9acee8b1f\">type 2</span> diabetes for both the mother and the child later in life.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased risk of <span class=\"customMeta\" data-dictid=\"c5ff3f2d211692777194ddf14e24c4\">obesity</span> and <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> syndrome</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Greater likelihood of the mother and child developing <span class=\"customMeta\" data-dictid=\"c5ff3f2d211692777194ddf14e24c4\">obesity</span> and <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> disorders.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the association of Project MONICA?", "options": [{"label": "A", "text": "Cardiovascular diseases", "correct": true}, {"label": "B", "text": "Cervical Cancer", "correct": false}, {"label": "C", "text": "Breast Cancer", "correct": false}, {"label": "D", "text": "Road Traffic Accidents", "correct": false}], "correct_answer": "A. Cardiovascular diseases", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\"&gt;Cardiovascular&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which type of aphasia is seen in the lesions of the posterior part of the superior temporal gyrus?", "options": [{"label": "A", "text": "Fluent", "correct": true}, {"label": "B", "text": "Non-fluent", "correct": false}, {"label": "C", "text": "Anomic", "correct": false}, {"label": "D", "text": "Conduction", "correct": false}], "correct_answer": "A. Fluent", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Wernicke's Aphasia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Broca's <span class=\"customMeta\" data-dictid=\"9b5386bf6216927771812526afb5e6\">Aphasia</span> (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Global Aphasia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Conduction <span class=\"customMeta\" data-dictid=\"9b5386bf6216927771812526afb5e6\">Aphasia</span> (Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Speech Output</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fluent</strong>, but paraphasic and circumlocutious, <span class=\"customMeta\" data-dictid=\"3c07f956e61692777190be7ce53d88\">jargon</span> speech</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Nonfluent</strong>, labored, dysarthric, telegraphic</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Nonfluent, severely impaired</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fluent, but many phonemic paraphasias</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Comprehension</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Impaired for spoken and written words</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intact, except for syntactically complex sentences</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Severely impaired</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intact for spoken language, impaired for reading aloud</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Repetition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Impaired</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Impaired</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Severely impaired</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Severely impaired, with phonemic paraphasias</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Naming</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Impaired, leading to neologisms</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Impaired</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Severely impaired</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Impaired, with phonemic paraphasias</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Writing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Impaired</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Impaired</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Severely impaired</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Impaired, with phonemic paraphasias</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Motor Output (Facial and Limb)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Often unremarkable (rare mild <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> flattening)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Right <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> weakness, hemiparesis, buccofacial apraxia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Right hemiplegia, hemisensory loss</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Varies depending on <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> site</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause (Common Lesions)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Posterior part of superior <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> gyrus</strong>, <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> <span class=\"customMeta\" data-dictid=\"1c78db47a01692777192b079f1bfca\">MCA</span> branches</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Inferior <span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\">frontal</span> gyrus</strong>, superior <span class=\"customMeta\" data-dictid=\"1c78db47a01692777192b079f1bfca\">MCA</span> branches</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Involves entire <span class=\"customMeta\" data-dictid=\"1c78db47a01692777192b079f1bfca\">MCA</span> distribution</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Arcuate fasciculus</strong>, <span class=\"customMeta\" data-dictid=\"1c78db47a01692777192b079f1bfca\">MCA</span> branches</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Associated Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Severe agitation, paranoia, possible right hemianopia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Right <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> weakness, hemiparesis, emotional distress</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Right hemiplegia, hemisensory loss, <span class=\"customMeta\" data-dictid=\"0600a6b52316927771899e12e7ec86\">homonymous</span> hemianopia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No significant associated features</p>\n</td>\n</tr>\n</tbody>\n\n<p><strong>References:</strong></p>\n<ul><li>↳ Harrison’s Principles of Internal Medicine, 21st Edition, Page 196,197</li><li>↳ https://www.ncbi.nlm.nih.gov/books/NBK441951/</li><li>↳ https://link.springer.com/referenceworkentry/10.1007/978-0-387-79948-3_856</li></u\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not an emergency contraceptive method?", "options": [{"label": "A", "text": "Danazol", "correct": true}, {"label": "B", "text": "CuT200", "correct": false}, {"label": "C", "text": "RU486", "correct": false}, {"label": "D", "text": "Combined high dose estrogen-progestin pills", "correct": false}], "correct_answer": "A. Danazol", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:613px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Complication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Macrosomia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Large birth weight of the baby (over 4,000 grams or 8 pounds 13 ounces), which can increase delivery complications</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Shoulder dystocia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Difficulty delivering the baby's shoulders after the head is delivered, which can lead to birth injuries and complications</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Neonatal hypoglycemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low <span class=\"customMeta\" data-dictid=\"88b48cf7241692777183e5f5b8adf1\">blood sugar</span> levels in the <span class=\"customMeta\" data-dictid=\"04df903fe8169277719383126b1b02\">newborn</span> due to elevated <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> levels during pregnancy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Preterm birth</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Delivery of the baby before 37 weeks of gestation, which increases the risk of health problems for the baby</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Respiratory <span class=\"customMeta\" data-dictid=\"afafb9026e1692777186e3dd168fa8\">distress</span> syndrome (RDS)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A breathing disorder in <span class=\"customMeta\" data-dictid=\"84f13673191692777196762b18e036\">premature</span> babies due to <span class=\"customMeta\" data-dictid=\"c219021c491692777189d289f1fc03\">immature</span> lungs</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Jaundice</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A yellowing of the baby's skin and eyes caused by high <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> levels</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Preeclampsia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High <span class=\"customMeta\" data-dictid=\"263ee5444e1692777183a7e8e704da\">blood pressure</span> and organ damage in the mother during pregnancy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type 2 diabetes later in life</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased risk of developing <span class=\"customMeta\" data-dictid=\"05e8c1df0d1692777201c9acee8b1f\">type 2</span> diabetes for both the mother and the child later in life</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Increased risk of <span class=\"customMeta\" data-dictid=\"c5ff3f2d211692777194ddf14e24c4\">obesity</span> and <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Greater likelihood of the mother and child developing <span class=\"customMeta\" data-dictid=\"c5ff3f2d211692777194ddf14e24c4\">obesity</span> and <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> disorders</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following organisms is responsible for the production of superantigens?", "options": [{"label": "A", "text": "Staphylococcus epidermidis", "correct": false}, {"label": "B", "text": "Streptococcus pyogenes", "correct": true}, {"label": "C", "text": "Clostridium perfringens", "correct": false}, {"label": "D", "text": "Vibrio cholerae", "correct": false}], "correct_answer": "B. Streptococcus pyogenes", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Virulence Factor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mechanism of Action</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Associated Diseases</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>M Protein</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surface protein</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Resists <span class=\"customMeta\" data-dictid=\"aa86b61bdd1692777195ea42ef0356\">phagocytosis</span> by inhibiting opsonization, interacts with host cell receptors</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pharyngitis,</li>\n<li>Rheumatic fever</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Streptolysin O and S </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hemolysins</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lyse red and white blood cells, and platelets; cause tissue damage</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pharyngitis,</li>\n<li>Skin infections</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Streptococcal <span class=\"customMeta\" data-dictid=\"c49139dccd169277719662aa0740c4\">Pyrogenic</span> Exotoxins (SPEs)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Exotoxins</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Act as superantigens,</strong> causing a massive immune response; associated with <span class=\"customMeta\" data-dictid=\"e64a23a26b16927771986c7f6b3e9a\">scarlet</span> fever and streptococcal toxic shock syndrome</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Scarlet fever,</li>\n<li>Toxic shock-like syndrome (TSLS)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hyaluronidase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Enzyme</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Degrades <span class=\"customMeta\" data-dictid=\"df6db1b3731692777189ce2c44007f\">hyaluronic acid</span> in the host's <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue, facilitating bacterial spread</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cellulitis,</li>\n<li>Necrotizing fasciitis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Streptokinase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Enzyme</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Converts <span class=\"customMeta\" data-dictid=\"bab1a0998e1692777195514ec82e5f\">plasminogen</span> to plasmin, dissolving blood clots and facilitating spread</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Deep tissue infections,</li>\n<li>Pharyngitis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>DNases (A, B, C, D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Enzymes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Depolymerize free DNA in pus, reducing <span class=\"customMeta\" data-dictid=\"2313fc54841692777202a008c72950\">viscosity</span> and aiding the spread</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Abscess formation,</li>\n<li>Skin infections</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>C5a Peptidase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Enzyme</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Degrades the <span class=\"customMeta\" data-dictid=\"0d70f956b016927771839d0cd35100\">C5a</span> component of the <span class=\"customMeta\" data-dictid=\"f0ff39a3fa1692777184cf743ca1e7\">complement</span> system, inhibiting <span class=\"customMeta\" data-dictid=\"131fe589f71692777184dc879b32db\">chemotaxis</span> of phagocytes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Immune evasion,</li>\n<li>Systemic infections</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Capsule</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Polysaccharide capsule</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Composed of hyaluronic acid; inhibits phagocytosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Severe <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> diseases,</li>\n<li>Immune evasion</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Bacterium</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Superantigen</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Streptococcus pyogenes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Streptococcal <span class=\"customMeta\" data-dictid=\"c49139dccd169277719662aa0740c4\">Pyrogenic</span> Exotoxins (SPEs)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Scarlet fever, Streptococcal Toxic Shock Syndrome (STSS)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Staphylococcus aureus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Toxic Shock Syndrome Toxin-1 (TSST-1), Enterotoxins</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Staphylococcal TSS, food poisoning</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which influenza virus caused the pandemic that took place in 2009?", "options": [{"label": "A", "text": "H1N1", "correct": true}, {"label": "B", "text": "H5N1", "correct": false}, {"label": "C", "text": "H5N7", "correct": false}, {"label": "D", "text": "H3N2", "correct": false}], "correct_answer": "A. H1N1", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - H1N\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the use of the instrument given below.", "options": [{"label": "A", "text": "For tubal ligation", "correct": true}, {"label": "B", "text": "For ligation of uterine artery during hysterectomy", "correct": false}, {"label": "C", "text": "Ovarian cystectomy", "correct": false}, {"label": "D", "text": "Ectopic pregnancy", "correct": false}], "correct_answer": "A. For tubal ligation", "question_images": ["https://image.prepladder.com/content/yRzcYqJofMF22bLGnAIK1746511468.png"], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Instrument</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Use</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Falope ring applicator</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Used to apply a small plastic or metal ring around the <span class=\"customMeta\" data-dictid=\"efc83dab2c1692777202b5d1d06c4f\">fallopian</span> tube</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Bipolar <span class=\"customMeta\" data-dictid=\"42f1e4deb8169277718412c0681a54\">coagulation</span> forceps</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Used for <span class=\"customMeta\" data-dictid=\"139e001e5a169277718314924dbacc\">cauterization</span> and sealing of the <span class=\"customMeta\" data-dictid=\"efc83dab2c1692777202b5d1d06c4f\">fallopian</span> tube</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hemostatic clips</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clips applied to the <span class=\"customMeta\" data-dictid=\"efc83dab2c1692777202b5d1d06c4f\">fallopian</span> tube to <span class=\"customMeta\" data-dictid=\"76d49f7565169277719462f3e985bb\">occlude</span> it</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Harmonic scalpel</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ultrasonic <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> instrument for cutting and coagulating tissue</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Laparoscopic scissors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Scissors designed for use during <span class=\"customMeta\" data-dictid=\"b506527af81692777191e0f69912f6\">laparoscopic</span> procedures</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Laparoscopic graspers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Graspers used to manipulate and hold tissue during laparoscopy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Trocars</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Instruments used to create access ports for <span class=\"customMeta\" data-dictid=\"b506527af81692777191e0f69912f6\">laparoscopic</span> procedures</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Monopolar electrocautery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Device that uses electrical current to cut or <span class=\"customMeta\" data-dictid=\"b3062c0c8c16927771846dd0fc1343\">coagulate</span> tissue</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 15-year-old girl presented with fatigue, chronic diarrhoea, weight loss, bone pain and abdominal distension. Investigations revealed iron deficiency anemia and osteoporosis. Which of the following is the single best test to be done for her evaluation?", "options": [{"label": "A", "text": "TSH levels", "correct": false}, {"label": "B", "text": "C-peptide levels", "correct": false}, {"label": "C", "text": "Urine sugar and ketone", "correct": false}, {"label": "D", "text": "IgA tissue transglutaminase antibody", "correct": true}], "correct_answer": "D. IgA tissue transglutaminase antibody", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the class of immunoglobulin shown in the image below.", "options": [{"label": "A", "text": "IgA", "correct": true}, {"label": "B", "text": "IgG", "correct": false}, {"label": "C", "text": "IgM", "correct": false}, {"label": "D", "text": "IgE", "correct": false}], "correct_answer": "A. IgA", "question_images": ["https://image.prepladder.com/content/QX0FAg9VkXDX99yBoX9s1746511475.png"], "explanation_images": ["https://image.prepladder.com/content/SNXylrrEe058CqZ3QxsY1746511537.png", "https://image.prepladder.com/content/rt9I33mMs7BcpKGVbvnt1746511656.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Immunoglobulin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Structure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Main Function</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Location</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>IgA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dimer (Secretory IgA), Monomer (Serum IgA)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mucosal immunity</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mucosal secretions (saliva, tears, GI, respiratory)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>IgG</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Monomer</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Long-term immunity, opsonization, <span class=\"customMeta\" data-dictid=\"f0ff39a3fa1692777184cf743ca1e7\">complement</span> activation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blood, <span class=\"customMeta\" data-dictid=\"ba366417791692777187229d34e597\">extracellular</span> fluids, <span class=\"customMeta\" data-dictid=\"5276da31d11692777195f0e82f5e1d\">placenta</span> (crosses)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>IgM</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pentamer (with J chain)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Primary immune response, <span class=\"customMeta\" data-dictid=\"f0ff39a3fa1692777184cf743ca1e7\">complement</span> activation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blood and <span class=\"customMeta\" data-dictid=\"4fb6bd90f016927771918d4a2993ed\">lymphatic</span> fluid</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>IgE</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Monomer</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Allergy, <span class=\"customMeta\" data-dictid=\"c0433f52ad1692777194c2ffb6fc63\">parasitic</span> immunity</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bound to <span class=\"customMeta\" data-dictid=\"1f95a52091169277719133cc234fe0\">mast</span> cells, basophils</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>IgD</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Monomer</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>B-cell <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> function</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Surface of <span class=\"customMeta\" data-dictid=\"c219021c491692777189d289f1fc03\">immature</span> B-cells</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the finding seen in this hysterosalpingogram:", "options": [{"label": "A", "text": "Bilateral hydrosalpinx", "correct": true}, {"label": "B", "text": "Extravasation into the venous system", "correct": false}, {"label": "C", "text": "Normal HSG", "correct": false}, {"label": "D", "text": "Bilateral cornual block", "correct": false}], "correct_answer": "A. Bilateral hydrosalpinx", "question_images": ["https://image.prepladder.com/notes/E6egpmFWnEXTxumKuGvu1746603751.png"], "explanation_images": ["https://image.prepladder.com/content/1AAe1yWZRPiFMVQTEu541746511771.png", "https://image.prepladder.com/content/bPrRms6iBmwhCLjEhuUt1746511771.png", "https://image.prepladder.com/notes/YgReKwYbbxXS9y1JSxRq1746603812.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following items is placed in the yellow bag for disposal?", "options": [{"label": "A", "text": "Blood bag", "correct": true}, {"label": "B", "text": "Gloves", "correct": false}, {"label": "C", "text": "Sharps", "correct": false}, {"label": "D", "text": "Urine bag", "correct": false}], "correct_answer": "A. Blood bag", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Colour</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type of waste</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Example of waste</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment and disposal</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Yellow </strong></p>\n<p style=\"text-align: center;\"> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Human <span class=\"customMeta\" data-dictid=\"116f86834a1692777181a914379270\">anatomical</span> waste.</li>\n<li>Animal <span class=\"customMeta\" data-dictid=\"116f86834a1692777181a914379270\">anatomical</span> waste.</li>\n<li>Soiled waste.</li>\n<li>Discarded or expired medicine.</li>\n<li>Microbiology, <span class=\"customMeta\" data-dictid=\"177a32fb7f1692777183fcc83ba413\">biotechnology</span> and other <span class=\"customMeta\" data-dictid=\"3ec60edb4a16927771842bb9fd9aa4\">clinical laboratory</span> waste.</li>\n<li>Chemical waste.</li>\n<li>Chemical liquid waste.</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Placenta.</li>\n<li>Post-operative body parts.</li>\n<li>Plaster of Paris (POP).</li>\n<li>Pathological waste.</li>\n<li>Cotton waste.</li>\n<li>Dressing materials.</li>\n<li>Beddings.</li>\n<li>Body fluid contaminated paper and cloth.</li>\n<li>Face mask, cap, shoe cover and head cover.</li>\n<li>Cytotoxic, expired and discarded medicines.</li>\n<li>Microbiology and <span class=\"customMeta\" data-dictid=\"177a32fb7f1692777183fcc83ba413\">biotechnology</span> lab waste.</li>\n<li>Blood bag <strong>(Option A)</strong></li>\n<li>Vacutainers with blood</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Incineration.</li>\n<li>Plasma pyrolysis.</li>\n<li>Deep burial.</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Red</strong></p>\n<p style=\"text-align: center;\"> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Contaminated waste that is recyclable.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Syringe without needles.</li>\n<li>Fixed needle syringes with their needle cut.</li>\n<li>IVset.</li>\n<li>Catheters.</li>\n<li>Gloves (soiled or unsoiled). <strong>(Option B)</strong></li>\n<li>Urine bag. <strong>(Option D)</strong></li>\n<li>Dialysis kit.</li>\n<li>IVbottles.</li>\n<li>Tubing's.</li>\n<li>Bottles.</li>\n<li>Vacutainers with needle cut.</li>\n<li>Vacutainers without blood.</li>\n<li>ELISA plate and vials not containing blood samples.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Autoclaving or microwaving/ hydroclaving followed by shredding or <span class=\"customMeta\" data-dictid=\"07bda0bb4f1692777193a54fe56f9c\">mutilation</span> and waste set to registered recyclers or for energy recovery/road making.</li>\n<li>Plastic waste should not be sent to landfill sites.</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>White</strong></p>\n<p style=\"text-align: center;\"> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Waste Sharps <strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Needles</li>\n<li>Syringes with fixed needles</li>\n<li>Blades</li>\n<li>Scalpers</li>\n<li>Trocar cannula</li>\n<li>Insulin pen needle</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Puncture proof , Leak proof, Tamper proof containers</li>\n<li>Autoclaving or <span class=\"customMeta\" data-dictid=\"2d95ddf7b8169277718654aee27077\">dry heat</span> <span class=\"customMeta\" data-dictid=\"f39be0f0871692777199459d86e0a7\">sterilization</span> followed by shredding or <span class=\"customMeta\" data-dictid=\"07bda0bb4f1692777193a54fe56f9c\">mutilation</span> or <span class=\"customMeta\" data-dictid=\"5a7f7caa7716927771870658b1c5cf\">encapsulation</span> in metal container or <span class=\"customMeta\" data-dictid=\"d8691a48a91692777184708a8f2f0c\">cement</span> concrete</li>\n<li>Or sent for final disposal to iron foundries or <span class=\"customMeta\" data-dictid=\"601fb1538a16927771987048f6e712\">sanitary</span> landfill or designated concrete waste sharp pit</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Blue</strong></p>\n<p style=\"text-align: center;\"> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Glassware or <span class=\"customMeta\" data-dictid=\"84433cae211692777192a484f539bc\">metallic</span> body implants.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Includes broken or discarded glass and <span class=\"customMeta\" data-dictid=\"84433cae211692777192a484f539bc\">metallic</span> objects that are contaminated.</li>\n<li>Glass:\n\t\t\t\t<ul>\n<li>Broken glass.</li>\n<li>Ampoules.</li>\n<li>Lab slide</li>\n</ul>\n</li>\n<li>Metals:\n\t\t\t\t<ul>\n<li>Nails.</li>\n<li>Metallic body implants.</li>\n<li>Scissors.</li>\n<li>Artificial pacemakers.</li>\n</ul>\n</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Cardboard boxes with blue coloured marking or blue coloured puncture- proof and tamper-proof containers.</li>\n<li>Disinfection (cleaning with <span class=\"customMeta\" data-dictid=\"24ff542ee616927771865a28edbc12\">detergent</span> and soaking in sodium hypochlorite) or autoclaving or microwaving or hydroclaving and then sent for recycling.</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following methods relies on the principles of behavioral sciences?", "options": [{"label": "A", "text": "Decision making", "correct": false}, {"label": "B", "text": "Systems analysis", "correct": false}, {"label": "C", "text": "Network analysis", "correct": false}, {"label": "D", "text": "Management by objective", "correct": true}], "correct_answer": "D. Management by objective", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Management by objectiv\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Zika virus is transmitted by:", "options": [{"label": "A", "text": "Aedes aegypti", "correct": true}, {"label": "B", "text": "Culex", "correct": false}, {"label": "C", "text": "Anopheles", "correct": false}, {"label": "D", "text": "Phlebotomus", "correct": false}], "correct_answer": "A. Aedes aegypti", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/bbTBteXidBG1iPPmoExq1746511837.png", "https://image.prepladder.com/content/eo7OB1wKHnno2wIb5KXN1746511945.png", "https://image.prepladder.com/content/hcRE1Nxyv41ao2omunol1746511954.png", "https://image.prepladder.com/content/nPGGHD9nCGNU9uvF2f2G1746511964.png", "https://image.prepladder.com/content/VWEFcZKx6TW72jgvkOce1746511977.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\"><strong>Anopheles</strong></td>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\"><strong>Culex</strong></td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Aedes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong> Mansonoides</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Rest: angled <span class=\"customMeta\" data-dictid=\"ff903efe48169277719050548575e6\">inclination</span> to surface</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Rest: <span class=\"customMeta\" data-dictid=\"b6f0b18c321692777189e5ba745828\">Hunchback</span> position</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Rest: <span class=\"customMeta\" data-dictid=\"b6f0b18c321692777189e5ba745828\">hunchback</span> position</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Rest: <span class=\"customMeta\" data-dictid=\"50bf7d28eb1692777199ceb59e36cb\">squatting</span> position</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Wings spotted</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">No white stripes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">White stripes all over the body</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">White spots on legs</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Both sexes: long palpi</p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Short palpi in females</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Malaria</p>\n<p style=\"text-align:center\"><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Japanese encephalitis, Filariasis, West Nile fever</p>\n<p style=\"text-align:center\"><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Dengue, Chikungunya, Rift valley fever, Zika virus, Yellow fever</p>\n<p style=\"text-align:center\"><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Brugian filariasis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Flight range - 10 kms.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Flight range - 100-200 mts</p>\n</td>\n<td style=\"border-color:#000000; border-style:solid; border-width:1px; text-align:center; vertical-align:top\"> </td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Anopheles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Culex</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Photo Credit: James Gathany Content Providers(s): CDC\" data-hash=\"\" data-license=\"Open access\" data-source=\"https://commons.wikimedia.org/wiki/File:Anopheles_albimanus_mosquito.jpg\" data-tags=\"\" height=\"211\" src=\"https://image.prepladder.com/content/eo7OB1wKHnno2wIb5KXN1746511945.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"US Centers for Disease Control - City of Jacksonville, FL\" data-hash=\"\" data-license=\"Open access\" data-source=\"https://en.wikipedia.org/wiki/Culex#/media/File:CPipFm.jpg\" data-tags=\"\" height=\"362\" src=\"https://image.prepladder.com/content/hcRE1Nxyv41ao2omunol1746511954.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Aedes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Mansonoides</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"James Gathany, CDC\" data-hash=\"\" data-license=\"Open access\" data-source=\"https://en.wikipedia.org/wiki/Aedes_albopictus#/media/File:CDC-Gathany-Aedes-albopictus-1.jpg\" data-tags=\"\" height=\"198\" src=\"https://image.prepladder.com/content/nPGGHD9nCGNU9uvF2f2G1746511964.png\" width=\"350\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Ajamma, Yvonne &amp; Villinger, Jandouwe &amp; Omondi, David &amp; Salifu, Daisy &amp; Onchuru, Thomas &amp; Njoroge, Laban &amp; Muigai, Anne &amp; Masiga, Daniel.\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Photographs-of-the-dorsal-view-of-mosquito-species-representing-the-seven-genera_fig5_305258780\" data-tags=\"\" height=\"343\" src=\"https://image.prepladder.com/content/VWEFcZKx6TW72jgvkOce1746511977.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the function of proteasomes?", "options": [{"label": "A", "text": "Protein folding", "correct": false}, {"label": "B", "text": "Post-translation modification", "correct": false}, {"label": "C", "text": "Protein degradation", "correct": true}, {"label": "D", "text": "Protein sorting", "correct": false}], "correct_answer": "C. Protein degradation", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In Sustainable Development Goal 3, the target 3.1 aims to reduce the Maternal Mortality Ratio by 2030 to_____ (per 1 lakh live births)?", "options": [{"label": "A", "text": "&amp;lt;70", "correct": true}, {"label": "B", "text": "&amp;lt; 100", "correct": false}, {"label": "C", "text": "&amp;lt; 50", "correct": false}, {"label": "D", "text": "&amp;lt;130", "correct": false}], "correct_answer": "A. &lt;70", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &amp;lt;7\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following contains the maximum amount of vitamin B12?", "options": [{"label": "A", "text": "Animal products", "correct": true}, {"label": "B", "text": "Green leafy vegetables", "correct": false}, {"label": "C", "text": "Roots and tubers", "correct": false}, {"label": "D", "text": "Vegetarian diet", "correct": false}], "correct_answer": "A. Animal products", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "If the percentage of thymine residues in DNA is 28%. What is the % of cytosine?", "options": [{"label": "A", "text": "28%", "correct": false}, {"label": "B", "text": "44%", "correct": false}, {"label": "C", "text": "36%", "correct": false}, {"label": "D", "text": "22%", "correct": true}], "correct_answer": "D. 22%", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What type of bags are used for the disposal of chemical waste?", "options": [{"label": "A", "text": "Yellow", "correct": true}, {"label": "B", "text": "White", "correct": false}, {"label": "C", "text": "Red", "correct": false}, {"label": "D", "text": "Green", "correct": false}], "correct_answer": "A. Yellow", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Yellow</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Colour</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type of waste</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Example of waste</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment and disposal</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Yellow (Option A)</strong></p>\n<p style=\"text-align: center;\"> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p>Human <span class=\"customMeta\" data-dictid=\"116f86834a1692777181a914379270\">anatomical</span> waste.</p>\n</li>\n<li>\n<p>Animal <span class=\"customMeta\" data-dictid=\"116f86834a1692777181a914379270\">anatomical</span> waste.</p>\n</li>\n<li>\n<p>Soiled waste.</p>\n</li>\n<li>\n<p>Discarded or expired medicine.</p>\n</li>\n<li>\n<p>Microbiology, <span class=\"customMeta\" data-dictid=\"177a32fb7f1692777183fcc83ba413\">biotechnology</span> and other <span class=\"customMeta\" data-dictid=\"3ec60edb4a16927771842bb9fd9aa4\">clinical laboratory</span> waste.</p>\n</li>\n<li>\n<p>Chemical waste.</p>\n</li>\n<li>\n<p>Chemical liquid waste.</p>\n</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p>Placenta.</p>\n</li>\n<li>\n<p>Post-operative body parts.</p>\n</li>\n<li>\n<p>Plaster of Paris (POP).</p>\n</li>\n<li>\n<p>Pathological waste.</p>\n</li>\n<li>\n<p>Cotton waste.</p>\n</li>\n<li>\n<p>Dressing materials.</p>\n</li>\n<li>\n<p>Beddings.</p>\n</li>\n<li>\n<p>Body fluid contaminated paper and cloth.</p>\n</li>\n<li>\n<p>Face mask, cap, shoe cover and head cover.</p>\n</li>\n<li>\n<p>Cytotoxic, expired and discarded medicines.</p>\n</li>\n<li>\n<p>Microbiology and <span class=\"customMeta\" data-dictid=\"177a32fb7f1692777183fcc83ba413\">biotechnology</span> lab waste.</p>\n</li>\n<li>\n<p>Blood bag</p>\n</li>\n<li>\n<p>Vacutainers with blood</p>\n</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p>Incineration.</p>\n</li>\n<li>\n<p>Plasma pyrolysis.</p>\n</li>\n<li>\n<p>Deep burial.</p>\n</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Red (Option C)</strong></p>\n<p style=\"text-align: center;\"> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Contaminated waste that is recyclable.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p>Syringe without needles.</p>\n</li>\n</ul>\n<ul>\n<li>\n<p>Fixed needle syringes with their needle cut.</p>\n</li>\n<li>\n<p>IVset.</p>\n</li>\n<li>\n<p>Catheters.</p>\n</li>\n<li>\n<p>Gloves (soiled or unsoiled).</p>\n</li>\n<li>\n<p>Urine bag.</p>\n</li>\n<li>\n<p>Dialysis kit.</p>\n</li>\n<li>\n<p>IVbottles.</p>\n</li>\n<li>\n<p>Tubing's.</p>\n</li>\n<li>\n<p>Bottles.</p>\n</li>\n<li>\n<p>Vacutainers with needle cut.</p>\n</li>\n<li>\n<p>Vacutainers without blood.</p>\n</li>\n<li>\n<p>ELISA plate and vials not containing blood samples.</p>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p>Autoclaving or microwaving/ hydroclaving followed by shredding or</p>\n</li>\n</ul>\n<p>mutilation and waste set to registered recyclers or for energy</p>\n<p>recovery/road making.</p>\n<ul>\n<li>\n<p>Plastic waste should not be sent to landfill sites.</p>\n</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>White (Option B)</strong></p>\n<p style=\"text-align: center;\"> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Waste Sharps</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p>Needles</p>\n</li>\n<li>\n<p>Syringes with fixed needles</p>\n</li>\n<li>\n<p>Blades</p>\n</li>\n<li>\n<p>Scalpers</p>\n</li>\n<li>\n<p>Trocar cannula</p>\n</li>\n<li>\n<p>Insulin pen needle</p>\n</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p>Puncture proof , Leak proof, Tamper proof containers</p>\n</li>\n<li>\n<p>Autoclaving or <span class=\"customMeta\" data-dictid=\"2d95ddf7b8169277718654aee27077\">dry heat</span> <span class=\"customMeta\" data-dictid=\"f39be0f0871692777199459d86e0a7\">sterilization</span> followed by shredding or <span class=\"customMeta\" data-dictid=\"07bda0bb4f1692777193a54fe56f9c\">mutilation</span> or <span class=\"customMeta\" data-dictid=\"5a7f7caa7716927771870658b1c5cf\">encapsulation</span> in metal container or <span class=\"customMeta\" data-dictid=\"d8691a48a91692777184708a8f2f0c\">cement</span> concrete</p>\n</li>\n<li>\n<p>Or sent for final disposal to iron foundries or <span class=\"customMeta\" data-dictid=\"601fb1538a16927771987048f6e712\">sanitary</span> landfill or designated concrete waste sharp pit</p>\n</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Blue</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Glassware or <span class=\"customMeta\" data-dictid=\"84433cae211692777192a484f539bc\">metallic</span> body implants.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p>Includes broken or discarded glass and <span class=\"customMeta\" data-dictid=\"84433cae211692777192a484f539bc\">metallic</span> objects that are contaminated.</p>\n</li>\n<li>\n<p>Glass:</p>\n<ul>\n<li>\n<p>Broken glass.</p>\n</li>\n<li>\n<p>Ampoules.</p>\n</li>\n<li>\n<p>Lab slide</p>\n</li>\n</ul>\n</li>\n<li>\n<p>Metals:</p>\n<ul>\n<li>\n<p>Nails.</p>\n</li>\n<li>\n<p>Metallic body implants.</p>\n</li>\n<li>\n<p>Scissors.</p>\n</li>\n<li>\n<p>Artificial pacemakers.</p>\n</li>\n</ul>\n</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p>Cardboard boxes with blue coloured marking or blue coloured puncture- proof and tamper-proof containers.</p>\n</li>\n<li>\n<p>Disinfection (cleaning with <span class=\"customMeta\" data-dictid=\"24ff542ee616927771865a28edbc12\">detergent</span> and soaking in sodium hypochlorite) or autoclaving or microwaving or hydroclaving and then sent for recycling.</p>\n</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable reason for the worsening of neurologic symptoms in a patient who initially showed improvement in blood picture after receiving a dose of 5mg folate for peripheral neuropathy and macrocytic anemia?", "options": [{"label": "A", "text": "Malabsorption of folate", "correct": false}, {"label": "B", "text": "Treatment with folate unmasking pyridoxine deficiency", "correct": false}, {"label": "C", "text": "Deficiency of folate reductase in CNS", "correct": false}, {"label": "D", "text": "Folate therapy using the B12 stores", "correct": true}], "correct_answer": "D. Folate therapy using the B12 stores", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/7zMVAE9v6GdzR8IhGVPE1746512910.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In which of the following analyses is the financial advantage quantified?", "options": [{"label": "A", "text": "Cost-effective analysis", "correct": false}, {"label": "B", "text": "Cost-benefit analysis", "correct": true}, {"label": "C", "text": "Network analysis", "correct": false}, {"label": "D", "text": "Input-Output analysis", "correct": false}], "correct_answer": "B. Cost-benefit analysis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Cost-benefit A\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient came to the hospital with a complaint of abdominal pain. Routine investigations were unremarkable. On observation, the urine turned black on standing. Which of the following enzymes is likely to be defective in this patient?", "options": [{"label": "A", "text": "Homogentisate oxidase", "correct": true}, {"label": "B", "text": "Xanthine oxidase", "correct": false}, {"label": "C", "text": "Phenylalanine hydroxylase", "correct": false}, {"label": "D", "text": "Dihydric orotate dehydrogenase", "correct": false}], "correct_answer": "A. Homogentisate oxidase", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old male presented with tachypnea and mental confusion. His blood sugar is 350mg/dl, pH-7.2, HCO3-10, pCO2-30. What is the metabolic abnormality?", "options": [{"label": "A", "text": "Metabolic alkalosis", "correct": false}, {"label": "B", "text": "Metabolic acidosis", "correct": true}, {"label": "C", "text": "Respiratory alkalosis", "correct": false}, {"label": "D", "text": "Respiratory acidosis", "correct": false}], "correct_answer": "B. Metabolic acidosis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The recommended temperature of a water bath for a patient with frostbite is", "options": [{"label": "A", "text": "37 degree C", "correct": true}, {"label": "B", "text": "42 degree C", "correct": false}, {"label": "C", "text": "32 degree C", "correct": false}, {"label": "D", "text": "30 degree C", "correct": false}], "correct_answer": "A. 37 degree C", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which demographic is most likely to present with warty lesions on the vulva, along with multiple warty growths around the anal canal, as observed during examination?", "options": [{"label": "A", "text": "Condyloma accuminata", "correct": true}, {"label": "B", "text": "Molluscum contagiosum", "correct": false}, {"label": "C", "text": "Chancroid", "correct": false}, {"label": "D", "text": "Herpes", "correct": false}], "correct_answer": "A. Condyloma accuminata", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/ZptbM4tCzxD88ItXOJyB1746603963.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All of the following is used in the management of breathless patients at a high altitude of 3000 mts except.", "options": [{"label": "A", "text": "Intravenous digoxin", "correct": true}, {"label": "B", "text": "Oxygen supplementation", "correct": false}, {"label": "C", "text": "Immediate descent", "correct": false}, {"label": "D", "text": "Acetazolamide", "correct": false}], "correct_answer": "A. Intravenous digoxin", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the drug that commonly leads to physical dependence?", "options": [{"label": "A", "text": "Ketamine", "correct": false}, {"label": "B", "text": "Heroin", "correct": true}, {"label": "C", "text": "LSD", "correct": false}, {"label": "D", "text": "Phencyclidine", "correct": false}], "correct_answer": "B. Heroin", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Drug Class</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Opioid (Narcotic)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Origin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Derived from morphine, which is extracted from the <span class=\"customMeta\" data-dictid=\"6bf1d11f281692777194e1d3517f12\">opium</span> <span class=\"customMeta\" data-dictid=\"29d080c8fb169277719630ecd0d756\">poppy</span> plant.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Forms</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Powder (white or brown), black <span class=\"customMeta\" data-dictid=\"3dabcf4a5b16927772000a8ba686e1\">tar</span> (sticky resin)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Route of Administration</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Injected, smoked, snorted, orally ingested</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Effects</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Euphoria</li>\n<li>Pain relief</li>\n<li>Relaxation</li>\n<li>Drowsiness</li>\n<li>Slowed breathing</li>\n<li>Sedation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Symptoms</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Drowsiness</li>\n<li>Nausea</li>\n<li>Vomiting</li>\n<li>Slow or shallow breathing</li>\n<li>Unconsciousness</li>\n<li>Overdose</li>\n<li>Constipation</li>\n<li>Dizziness</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Long-Term Risks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Addiction</li>\n<li>Liver and <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> damage</li>\n<li>Collapsed veins (if injected)</li>\n<li>Lung complications</li>\n<li>Brain damage</li>\n<li>Overdose</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Withdrawal Symptoms</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Anxiety</li>\n<li>Sweating</li>\n<li>Muscle pain</li>\n<li>Nausea</li>\n<li>Vomiting</li>\n<li>Diarrhea</li>\n<li>Insomnia</li>\n<li>Cravings</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Overdose Symptoms</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Slow or difficult breathing</li>\n<li>Blue lips or nails</li>\n<li>Unconsciousness</li>\n<li>Pinpoint pupils</li>\n<li>Death</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Treatment</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Methadone or <span class=\"customMeta\" data-dictid=\"b15fb72c3c16927771837d01fe5d28\">buprenorphine</span> replacement therapy</li>\n<li>Counseling and rehabilitation.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the subsequent impacts of puberty are not influenced by estrogen?", "options": [{"label": "A", "text": "Hair growth", "correct": true}, {"label": "B", "text": "Cervical mucus secretion", "correct": false}, {"label": "C", "text": "Vaginal cornification", "correct": false}, {"label": "D", "text": "Menstruation", "correct": false}], "correct_answer": "A. Hair growth", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is true about the structural organization of proteins?", "options": [{"label": "A", "text": "Tertiary structure is three-dimensional", "correct": true}, {"label": "B", "text": "The secondary structure is stabilized by disulfide bonds.", "correct": false}, {"label": "C", "text": "Primary, secondary, and tertiary structures are destroyed by denaturation.", "correct": false}, {"label": "D", "text": "The secondary and tertiary structure depends upon amino acid sequence.", "correct": false}], "correct_answer": "A. Tertiary structure is three-dimensional", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/YGErXeNE35VjUtiZeWbg1746514429.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 33-year-old female patient comes with complaints of severe menorrhagia for the past 3 months. The duration and regularity of her menstrual cycles are normal. What is the most appropriate next step?", "options": [{"label": "A", "text": "Uterine artery embolization", "correct": false}, {"label": "B", "text": "Endometrial ablation", "correct": false}, {"label": "C", "text": "Hormonal therapy", "correct": true}, {"label": "D", "text": "Hysterectomy", "correct": false}], "correct_answer": "C. Hormonal therapy", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which among the following absorbs the least water?", "options": [{"label": "A", "text": "Mucilage", "correct": false}, {"label": "B", "text": "Cellulose", "correct": true}, {"label": "C", "text": "Gums", "correct": false}, {"label": "D", "text": "Pectin", "correct": false}], "correct_answer": "B. Cellulose", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a civil negligence case against a doctor, who is responsible for providing evidence?", "options": [{"label": "A", "text": "Patient", "correct": true}, {"label": "B", "text": "Police not under the rank of sub-inspector", "correct": false}, {"label": "C", "text": "Magistrate", "correct": false}, {"label": "D", "text": "Doctor", "correct": false}], "correct_answer": "A. Patient", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:679px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Civil Negligence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Criminal Negligence</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Offense</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No specific and clear violation of law</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Must have specifically violated a particular criminal law</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Negligence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Simple absence of care and skill</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gross negligence, inattention, or lack of competence</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Conduct of physician</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Compared to a generally accepted simple standard of conduct</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Not compared to a single test</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Consent for act</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Good defense, cannot recover damages</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Not a defense, can be prosecuted</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Trial by</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Civil court</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Criminal court</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Evidence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Strong evidence is sufficient</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Guilt must be proved beyond reasonable doubt</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Punishment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Liable to pay damages</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Imprisonment, fine, or both</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Contributory negligence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Defense for doctor </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Not a defense</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Double jeopardy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cannot be tried twice for the same offense</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Can be tried twice for the same crime</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Damage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Repairable damage or harm to patient</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Irreparable damage to the patient</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dispute</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Between two parties in their individual capacities</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Between the State and the offending doctor</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complainant</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sufferer party is the complainant</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Public prosecutor on behalf of the State is the complainant</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During a routine antenatal checkup at 18 weeks of gestation, a pregnant woman's abdominal examination showed that the size of her uterus was equivalent to that of a 16-week gestation. Additionally, an ultrasound detected the presence of oligohydramnios. What is the probable cause for these findings?", "options": [{"label": "A", "text": "Renal agenesis", "correct": true}, {"label": "B", "text": "Fetal anemia", "correct": false}, {"label": "C", "text": "Barter syndrome", "correct": false}, {"label": "D", "text": "Anencephaly", "correct": false}], "correct_answer": "A. Renal agenesis", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following poisons can be found even in skeletonized remains of the body?", "options": [{"label": "A", "text": "Arsenic", "correct": true}, {"label": "B", "text": "Carbon monoxide", "correct": false}, {"label": "C", "text": "Hydrogen sulphide", "correct": false}, {"label": "D", "text": "Phoshorus", "correct": false}], "correct_answer": "A. Arsenic", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/QojJ10Vm5w8sJLnz4iV21746515070.png", "https://image.prepladder.com/content/TSR9Q7qMqwYMXgbwvlgq1746515071.png", "https://image.prepladder.com/content/5Bc1G5qqH9JuUDi4ZAX91746515071.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:649px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>External findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Internal findings </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Emaciation</li>\n<li>Raindrop pigmentation</li>\n<li>Keratosis</li>\n<li>Alopecia</li>\n<li>White streaks on nails (Aldrich Mees’ lines)</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Yannick Trottier \" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Mees%27_lines#/media/File:Mees'_lines.jpg\" data-tags=\"\" height=\"181\" src=\"https://image.prepladder.com/content/QojJ10Vm5w8sJLnz4iV21746515070.png\" width=\"188\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>Jaundice and muscle wasting,</li>\n<li>Nasal <span class=\"customMeta\" data-dictid=\"d783117d991692777198108af42c05\">septum</span> ulceration.</li>\n<li>Sunken eyeballs</li>\n<li>Cyanosed and shrunken body.</li>\n<li><strong>Rigor mortis (sets in late and persists for a prolonged duration) </strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Reddening of stomach <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> (red velvet or strawberry)</strong> due to <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> congestion.</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"184\" src=\"https://image.prepladder.com/content/TSR9Q7qMqwYMXgbwvlgq1746515071.png\" width=\"184\"/></p>\n<ul>\n<li><strong>Flea-bitten appearance of the stomach </strong>(due to <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> haemorrhages).</li>\n<li><strong>The <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and presence of “rice water” contents in the intestines.</strong></li>\n<li><strong>Subendocardial haemorrhages in the heart.</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"İnanır, Nursel &amp; Cetin, Selçuk &amp; Eren, Filiz &amp; Eren, Bülent.\" data-hash=\"\" data-license=\"CC BY NC 4.0\" data-source=\"https://www.researchgate.net/figure/Subendocardial-hemorrhage-localized-on-septum_fig1_282686793\" data-tags=\"\" height=\"142\" src=\"https://image.prepladder.com/content/5Bc1G5qqH9JuUDi4ZAX91746515071.png\" width=\"164\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>Fatty <span class=\"customMeta\" data-dictid=\"df4f1758e2169277718697ae66f3dd\">degeneration</span> of the heart, liver, and kidneys.</li>\n<li>Along with routine <span class=\"customMeta\" data-dictid=\"93943f6ee2169277720298325fd255\">viscera</span> and body fluids, the items preserved for chemical analysis are:\n\t\t\t\t<ul>\n<li>\n<ul>\n<li><strong>A piece of long bone (preferably femur)</strong></li>\n<li>A bunch of pulled <span class=\"customMeta\" data-dictid=\"038a2a2fd4169277719894dc7db4bb\">scalp</span> hair</li>\n<li>A <span class=\"customMeta\" data-dictid=\"b3c25aa68616927772025ab4ff7a11\">wedge</span> of muscle</li>\n<li>A small portion of skin (from the back of the trunk)</li>\n</ul>\n</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the type of cartilage shown in the image below:", "options": [{"label": "A", "text": "Hyaline cartilage", "correct": false}, {"label": "B", "text": "Elastic cartilage", "correct": true}, {"label": "C", "text": "Articular cartilage", "correct": false}, {"label": "D", "text": "Fibrocartilage", "correct": false}], "correct_answer": "B. Elastic cartilage", "question_images": ["https://image.prepladder.com/content/FzgazgPYdqlmNZStugYF1746514933.png"], "explanation_images": ["https://image.prepladder.com/content/7fqWmj6Ads8EqrHVtTO81746515008.png", "https://image.prepladder.com/content/KZwXHjbBz63ozJoqIG1N1746515020.png", "https://image.prepladder.com/content/bbMGIz3xGMJfC60lpxaC1746515031.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Characteristic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Hyaline <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">Cartilage</span> (Most Common)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Elastic Cartilage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Fibrocartilage</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Matrix appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Homogeneous, basophilic</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Contains <span class=\"customMeta\" data-dictid=\"2dba7c03f61692777187254f866bcc\">elastic</span> fiber network</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Numerous <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">collagen</span> bundles</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chondrocyte arrangement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Groups (cell nests/isogenous groups)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Similar to hyaline</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Single rows or <span class=\"customMeta\" data-dictid=\"e2c83bc4de1692777190e11dbe140f\">isogenous</span> groups</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Perichondrium</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present (except in <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">articular</span> cartilage)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Present</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Absent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Main fiber type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type II collagen</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elastic fibers</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type I (primarily) and Type II collagen</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Main functions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Structural support, forms <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">articular</span> surfaces</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Provides flexibility and resilience</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Resists <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> and shearing, shock absorption</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Examples</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Costal cartilage, <span class=\"customMeta\" data-dictid=\"c739a6fb2b1692777200e2ada8023c\">tracheal</span> rings, <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">articular</span> cartilage</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Auricle, epiglottis, <span class=\"customMeta\" data-dictid=\"f17057f75016927771829e70074368\">auditory</span> tube</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intervertebral discs, menisci</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following structures is most likely to be damaged when the obstetrician observes that the episiotomy performed during a successful delivery has extended posteriorly beyond the perineal body?", "options": [{"label": "A", "text": "External anal sphincter", "correct": true}, {"label": "B", "text": "Ischiocavernosus", "correct": false}, {"label": "C", "text": "Bulbospongiosis", "correct": false}, {"label": "D", "text": "Urethral sphincter", "correct": false}], "correct_answer": "A. External anal sphincter", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a dead body, bloating of face, tongue protrusions were noted along with the findings in the image. Identify the phenomenon:", "options": [{"label": "A", "text": "Electrocution", "correct": false}, {"label": "B", "text": "Crocodile burns", "correct": false}, {"label": "C", "text": "Scalds", "correct": false}, {"label": "D", "text": "Putrefaction", "correct": true}], "correct_answer": "D. Putrefaction", "question_images": ["https://image.prepladder.com/content/GdcApNmgeT4fJWecB42p1746515142.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In which of the following situations is the equation V/Q = infinity accurate?", "options": [{"label": "A", "text": "Foreign body obstruction in the bronchus", "correct": false}, {"label": "B", "text": "Equal to dead space", "correct": true}, {"label": "C", "text": "When O2 and CO2 ratio is equal", "correct": false}, {"label": "D", "text": "The PO2 of alveolar air is 159 mmHg and PCO2 is 40 mmHg", "correct": false}], "correct_answer": "B. Equal to dead space", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The type of joint marked in the image below is:", "options": [{"label": "A", "text": "Syndesmosis", "correct": false}, {"label": "B", "text": "Synarthrosis", "correct": false}, {"label": "C", "text": "Synchondrosis", "correct": false}, {"label": "D", "text": "Synovial", "correct": true}], "correct_answer": "D. Synovial", "question_images": ["https://image.prepladder.com/content/Q8uMOLCJYtCjDMACNgzs1746515161.png"], "explanation_images": ["https://image.prepladder.com/content/R9VspEZeyDI6PdVqqO551746515234.png", "https://image.prepladder.com/content/xWmS0yaT7xZowoRA45Db1746515242.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Type of joint</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Examples</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hinge Joint</strong><strong> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Elbow joint, Knee joint, Temporomandibular joint.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pivot Joint</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Superior <span class=\"customMeta\" data-dictid=\"6c5e87b03d1692777197e1150ae78a\">radioulnar</span> joint, C1 and C2 joint</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ball-and-Socket Joint</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Shoulder (glenohumeral) joint, Hip joint</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Saddle Joint</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sternoclavicular joint, Carpometacarpal joint of the thumb</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ellipsoid (Condyloid) Joint</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Radiocarpal (wrist) joint, <span class=\"customMeta\" data-dictid=\"1ea315da6d169277718223b6b71942\">atlantooccipital</span> joint, Metacarpophalangeal joints</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Hinge Joints (Bicondylar Joints) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Pivot Joints (Trochoid Joints)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Movement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Predominantly <span class=\"customMeta\" data-dictid=\"084579203f169277720106a16f3480\">uniaxial</span> with limited <span class=\"customMeta\" data-dictid=\"8342f520cf1692777197dee4e4e5c3\">rotation</span> around a second orthogonal axis.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Uniaxial <span class=\"customMeta\" data-dictid=\"8342f520cf1692777197dee4e4e5c3\">rotation</span> around an axis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Structure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Formed by two <span class=\"customMeta\" data-dictid=\"00ab88c6091692777185ea2685fa40\">convex</span> condyles that articulate with <span class=\"customMeta\" data-dictid=\"9b5c0ed1601692777184e597f453c9\">concave</span> or flat surfaces.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involves an <span class=\"customMeta\" data-dictid=\"83ceeee3151692777194ec61af5c55\">osseous</span> <span class=\"customMeta\" data-dictid=\"20e5c798981692777195a599eb19c8\">pivot</span> rotating within an osteoligamentous ring, or vice versa.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Examples</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Knee Joint- </strong>Condyles may be within a single <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> capsule.</li>\n<li><strong>Temporomandibular joint- </strong>In separate capsules that work together.]</li>\n<li>Humeroulnar joint in the elbow.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Superior <span class=\"customMeta\" data-dictid=\"6c5e87b03d1692777197e1150ae78a\">radioulnar</span> joint-</strong> The head of the <span class=\"customMeta\" data-dictid=\"ec7c10c0421692777197d151a4c0b5\">radius</span> rotates within the <span class=\"customMeta\" data-dictid=\"96f5104d6816927771816ac8dfceeb\">annular</span> <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> and <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> notch.</li>\n<li>Dens of the <span class=\"customMeta\" data-dictid=\"3c28fd47f71692777182efbbaa5f6d\">axis</span> (C2 vertebra) project into altas.</li>\n<li><strong>C1 and C2 joint</strong> that allows the head to move back and forth.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Images</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"OpenStax College\" data-hash=\"\" data-license=\"CC BY 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:909_Types_of_Synovial_Joints.jpg\" data-tags=\"\" height=\"273\" src=\"https://image.prepladder.com/content/R9VspEZeyDI6PdVqqO551746515234.png\" width=\"309\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"OpenStax College\" data-hash=\"\" data-license=\"CC BY 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:909_Types_of_Synovial_Joints.jpg\" data-tags=\"\" height=\"256\" src=\"https://image.prepladder.com/content/xWmS0yaT7xZowoRA45Db1746515242.png\" width=\"475\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the cell marked in the histological image of the cerebellum shown below:", "options": [{"label": "A", "text": "Purkinje cells", "correct": true}, {"label": "B", "text": "Basket cells", "correct": false}, {"label": "C", "text": "Golgi cells", "correct": false}, {"label": "D", "text": "Granule cell", "correct": false}], "correct_answer": "A. Purkinje cells", "question_images": ["https://image.prepladder.com/content/R9k7dKqc1067yOAQosAT1746515353.png"], "explanation_images": ["https://image.prepladder.com/content/MZ2RqMoKZZtt1CulHD1N1746515447.png", "https://image.prepladder.com/content/zPy09712gZOv4fv1r62s1746515460.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Layers of the cerebellar cortex</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Molecular (plexiform) layer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Purkinje cell layer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Granular layer</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It primarily contains numerous <span class=\"customMeta\" data-dictid=\"77f797c5e8169277718535480fa7fd\">dendritic</span> branches from Purkinje cells, with relatively few widely spaced nerve cells.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It consists of a single row of large flask-shaped cells, the <strong>Purkinje cells</strong>.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The inner <span class=\"customMeta\" data-dictid=\"4f63eb15be169277718848d4b4978b\">granular</span> layer is made up of many closely packed small<strong> <span class=\"customMeta\" data-dictid=\"fd69fc99d41692777188cc051aafa5\">granule</span> cells</strong>, along with a few larger <strong>Golgi cells.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>These nerve cells are of two types:</p>\n<p>(a) <strong>Basket cells </strong></p>\n<p>(b) Stellate cells.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The axons of Purkinje cells are the only output from the <span class=\"customMeta\" data-dictid=\"8c584f1d6a16927771847eabd3ce01\">cerebellar cortex</span> and have an <strong>inhibitory</strong> effect on the <span class=\"customMeta\" data-dictid=\"892754df9f169277719002da27f662\">intracerebellar</span> nuclei.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Golgi cells are<strong> inhibitory</strong> while the <span class=\"customMeta\" data-dictid=\"4f63eb15be169277718848d4b4978b\">granular</span> cells are <strong>excitatory.</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What does the given barium swallow film show?", "options": [{"label": "A", "text": "Aortic aneurysm", "correct": false}, {"label": "B", "text": "Pharyngeal pouch", "correct": true}, {"label": "C", "text": "Carotid body tumour", "correct": false}, {"label": "D", "text": "Esophageal carcinoma", "correct": false}], "correct_answer": "B. Pharyngeal pouch", "question_images": ["https://image.prepladder.com/content/TS8sDKCL86TeGi3JG8sP1747216590.png"], "explanation_images": ["https://image.prepladder.com/content/CitDWLLKOaMjaQ1MeQ4Y1747216601.png", "https://image.prepladder.com/content/lC4XVms6ve2vLd3MPzp61748377745.png", "https://image.prepladder.com/content/CvJAFmiv2BegEOUbyU621748377719.png", "https://image.prepladder.com/content/0JLgk2Hmr8JkmDNFPuZ51746515531.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:634px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Zenker's diverticulum</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Dysphagia is the most prominent feature appears when the <span class=\"customMeta\" data-dictid=\"fba459ae6d1692777196f4374e9ac1\">pouch</span> gets filled with food and presses on the oesophagus.</li>\n<li>Gurgling sound is produced on swallowing.</li>\n<li>Regurgitation at night from undigested food causes <span class=\"customMeta\" data-dictid=\"8f02e74e821692777185a0c005c508\">cough</span> and <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> pneumonia.</li>\n<li>Halitosis(Chronic bad breathe)</li>\n<li>Malnourished due to dysphagia.</li>\n<li>Associated <span class=\"customMeta\" data-dictid=\"d39e7332f61692777189b4b278093d\">hiatus</span> hernia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Barium swallow </strong>provides information regarding the size, location, and character of the mucosal lining.</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"288\" src=\"https://image.prepladder.com/content/CitDWLLKOaMjaQ1MeQ4Y1747216601.png\" width=\"265\"/></p>\n<ul>\n<li><strong>Endoscopy</strong> reveals <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> and pooling of food in the diverticulum.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment:</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Excision of the <span class=\"customMeta\" data-dictid=\"fba459ae6d1692777196f4374e9ac1\">pouch</span> and <span class=\"customMeta\" data-dictid=\"07bb7766221692777185a58cad9233\">cricopharyngeal</span> myotomy</strong> was done through a <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> approach.</li>\n<li><strong>Dohlman’s procedure: </strong>Partition wall between the <span class=\"customMeta\" data-dictid=\"84f4cb0ade16927771940b83eacc37\">oesophagus</span> and the <span class=\"customMeta\" data-dictid=\"fba459ae6d1692777196f4374e9ac1\">pouch</span> is exposed and divided by <span class=\"customMeta\" data-dictid=\"24bfc6e0cc16927771862d94b32d73\">diathermy</span> through a weerda scope.</li>\n<li><strong>Endoscopic laser treatment:</strong> Partition wall between the <span class=\"customMeta\" data-dictid=\"84f4cb0ade16927771940b83eacc37\">oesophagus</span> and the <span class=\"customMeta\" data-dictid=\"fba459ae6d1692777196f4374e9ac1\">pouch</span> is exposed and divided by CO2 laser using an endoscope. This procedure is known to have fewer recurrences and faster improvement in symptoms.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What could be the most likely reason for a patient presenting with chronic non-pitting edema in the lower extremities?", "options": [{"label": "A", "text": "Lymphedema", "correct": true}, {"label": "B", "text": "Arterial Disorders", "correct": false}, {"label": "C", "text": "Venous Disorders", "correct": false}, {"label": "D", "text": "Coronary heart disease", "correct": false}], "correct_answer": "A. Lymphedema", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Causes of Primary Lymphedema</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Congenital <span class=\"customMeta\" data-dictid=\"e03e1c0c3016927771916c29e57df1\">Lymphedema</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lymphedema <span class=\"customMeta\" data-dictid=\"96400dd4d61692777196c9a5ea1493\">Praecox</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lymphedema Tarda </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Age: Seen in &lt; 1 year of age</li>\n<li>Present at birth.</li>\n<li>Lower limb, genitalia, and face are involved.</li>\n<li>Usually, B/L and multiple limbs are involved.</li>\n<li>Familial version of <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> <span class=\"customMeta\" data-dictid=\"e03e1c0c3016927771916c29e57df1\">lymphedema</span> – known as <strong>Milroy’s disease.</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>M/C type of primary <span class=\"customMeta\" data-dictid=\"e03e1c0c3016927771916c29e57df1\">lymphedema</span> (&gt;90% of cases).</li>\n<li>Age: 1 to 35 years.</li>\n<li>M/C seen in females.</li>\n<li>Usually U/L.</li>\n<li>Involves calf and foot</li>\n<li>Familial version of <span class=\"customMeta\" data-dictid=\"e03e1c0c3016927771916c29e57df1\">lymphedema</span> <span class=\"customMeta\" data-dictid=\"96400dd4d61692777196c9a5ea1493\">praecox</span> - known as <strong>Meig's disease.</strong></li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Age: Usually seen in &gt; 35 years age group</li>\n<li>It is a rare disease.</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Secondary Lymphedema</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Filariasis</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>MC overall cause</strong> of <span class=\"customMeta\" data-dictid=\"e03e1c0c3016927771916c29e57df1\">lymphedema</span> worldwide</li>\n<li><strong>MC secondary cause</strong> of lymphedema</li>\n<li>Lymphoedema due to<strong> <span class=\"customMeta\" data-dictid=\"4fb6bd90f016927771918d4a2993ed\">Lymphatic</span> obstruction</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Surgery</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Axillary block dissection-</strong>\n<ul>\n<li><strong>MC cause of secondary lymphedema</strong> in the USA</li>\n<li><strong>MC <span class=\"customMeta\" data-dictid=\"36ddb6e17916927771892e93a27c53\">iatrogenic</span> cause</strong> of secondary lymphedema</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li>Inguinal block dissection</li>\n<li>Lymphedema due to <strong>Lymphatic disruption</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Infections</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Tuberculosis</li>\n<li>Syphilis</li>\n<li>Fungal and Bacterial infections</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Other causes:</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Trauma</li>\n<li>Malignancy</li>\n<li>Radiotherapy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following clotting factors would have decreased gamma carboxyglutamate residue in patients on warfarin therapy?", "options": [{"label": "A", "text": "Factor 2", "correct": true}, {"label": "B", "text": "Factor 11", "correct": false}, {"label": "C", "text": "Tissue factor", "correct": false}, {"label": "D", "text": "Factor 5", "correct": false}], "correct_answer": "A. Factor 2", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/1Y591eDnwNz42HXToxFj1746515624.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "From which of the following structures does the saccule develop?", "options": [{"label": "A", "text": "Saculus anterior", "correct": false}, {"label": "B", "text": "Saculus posterior", "correct": false}, {"label": "C", "text": "Pars superior", "correct": false}, {"label": "D", "text": "Pars inferior", "correct": true}], "correct_answer": "D. Pars inferior", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the sign in the image given below:", "options": [{"label": "A", "text": "Popeye sign", "correct": true}, {"label": "B", "text": "Hill-Sachs sign", "correct": false}, {"label": "C", "text": "Griesinger sign", "correct": false}, {"label": "D", "text": "Rising sun sign", "correct": false}], "correct_answer": "A. Popeye sign", "question_images": ["https://image.prepladder.com/content/cYcx8xtOT62ez3q0thpD1746515631.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 38-year-old man was brought to the emergency department after sustaining an RTA and injury to the lower chest. On presentation, the patient is stable, and vitals are normal. Chest radiography showed clear lung fields. What is the next step in management?", "options": [{"label": "A", "text": "eFAST", "correct": true}, {"label": "B", "text": "Tube thoracostomy", "correct": false}, {"label": "C", "text": "CECT chest", "correct": false}, {"label": "D", "text": "CECT abdomen", "correct": false}], "correct_answer": "A. eFAST", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following does not represent a characteristic of tubercular otitis media?", "options": [{"label": "A", "text": "Ear ache", "correct": true}, {"label": "B", "text": "Multiple perforations", "correct": false}, {"label": "C", "text": "Pale granulation", "correct": false}, {"label": "D", "text": "Foul smelling ear discharge", "correct": false}], "correct_answer": "A. Ear ache", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is true about the flap given in the image?", "options": [{"label": "A", "text": "Pedicled TRAM based on superior epigastric artery", "correct": false}, {"label": "B", "text": "Free TRAM based on superior and inferior epigastric artery", "correct": false}, {"label": "C", "text": "DIEP based on deep inferior epigastric artery", "correct": true}, {"label": "D", "text": "Lower abdominal fat-based inferior epigastric vessels", "correct": false}], "correct_answer": "C. DIEP based on deep inferior epigastric artery", "question_images": ["https://image.prepladder.com/content/uXgqYgMGS5kkUDMualL11746515823.png"], "explanation_images": ["https://image.prepladder.com/content/D7GddIizWvjkLm15s0ZD1746515872.png", "https://image.prepladder.com/content/xZnFoWVBXzCxtiv1hAgv1746515873.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Breast <span class=\"customMeta\" data-dictid=\"b29f3bf7cd1692777197ee03d829e9\">Reconstruction</span> Flaps</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Flaps</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Correlation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Transverse <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">Rectus</span> Abdominis Muscle <span class=\"customMeta\" data-dictid=\"7eae099d8d1692777202469603e6ed\">Flap</span> (TRAM)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Free <span class=\"customMeta\" data-dictid=\"7eae099d8d1692777202469603e6ed\">flap</span> involves using tissue from the abdomen, including both skin and muscle <strong>(Option A ruled out)</strong></li>\n<li>Most commonly used <span class=\"customMeta\" data-dictid=\"7eae099d8d1692777202469603e6ed\">flap</span> but not the best flap</li>\n<li>It is based on <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> epigastric vessels</li>\n<li>Disadvantage: causes weakness in <span class=\"customMeta\" data-dictid=\"fab77fbe55169277719011d192986d\">infra</span> <span class=\"customMeta\" data-dictid=\"9cc3973459169277720194a0847477\">umbilical</span> region</li>\n</ul>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"278\" src=\"https://image.prepladder.com/content/D7GddIizWvjkLm15s0ZD1746515872.png\" width=\"300\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Deep <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">Inferior</span> Epigastric <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> <span class=\"customMeta\" data-dictid=\"5afc9732fd1692777195b9482bf3c2\">Perforator</span> <span class=\"customMeta\" data-dictid=\"7eae099d8d1692777202469603e6ed\">flap</span> (DIEP)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Flap which uses skin and fat from lower abdomen, but spares <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> muscles</li>\n<li>Best <span class=\"customMeta\" data-dictid=\"7eae099d8d1692777202469603e6ed\">flap</span> for breast <span class=\"customMeta\" data-dictid=\"b29f3bf7cd1692777197ee03d829e9\">reconstruction</span> as there is no risk of <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> and muscle weakness</li>\n</ul>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"323\" src=\"https://image.prepladder.com/content/xZnFoWVBXzCxtiv1hAgv1746515873.png\" width=\"522\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Latissimus <span class=\"customMeta\" data-dictid=\"5125f3ab2b16927771860f1acf2bad\">Dorsi</span> Flap</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Flap, which uses <span class=\"customMeta\" data-dictid=\"12ad4210e4169277719111f356b7ba\">Latissimus</span> <span class=\"customMeta\" data-dictid=\"5125f3ab2b16927771860f1acf2bad\">dorsi</span> muscle, skin and fat</li>\n<li>It is a type of <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> <span class=\"customMeta\" data-dictid=\"7eae099d8d1692777202469603e6ed\">flap</span> based on thoracodorsal vessels.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Where is the location of the lesion in Wernicke's hemianopic pupil?", "options": [{"label": "A", "text": "Optic nerve", "correct": false}, {"label": "B", "text": "Optic tract", "correct": true}, {"label": "C", "text": "Optic radiation", "correct": false}, {"label": "D", "text": "Optic chiasma", "correct": false}], "correct_answer": "B. Optic tract", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/yzlg3KBGcBkeyWrPrN7W1746515896.png", "https://image.prepladder.com/content/dYiz6vpXw8nn3hmLDVpD1746515906.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p style=\"text-align: center;\"><strong>Lesion Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p style=\"text-align: center;\"><strong>Visual Field Defect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p style=\"text-align: center;\"><strong>Pupillary Reflex</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p style=\"text-align: center;\"><strong>Congruity</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Optic <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">Tract</span> (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Homonymous hemianopia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>RAPD</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Incongruous (defect may not match)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Lateral <span class=\"customMeta\" data-dictid=\"00b4dbe9e4169277718881a95f7864\">Geniculate</span> Body (LGB)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Homonymous hemianopia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Incongruous (less congruous)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Optic Radiation</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Inferior or superior <span class=\"customMeta\" data-dictid=\"0600a6b52316927771899e12e7ec86\">homonymous</span> <span class=\"customMeta\" data-dictid=\"e0b79d0fde16927771965173ff3031\">quadrantanopia</span> or hemianopia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Incongruous</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Visual Cortex</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Homonymous hemianopia, often with <span class=\"customMeta\" data-dictid=\"ebad8eb48c1692777191b5de5d04a1\">macular</span> sparing</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Congruous</strong></p>\n<p><strong>(more consistent)</strong></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Visual <span class=\"customMeta\" data-dictid=\"3aa5abc2fa169277719488e088076d\">Pathway</span> Lesions and Defects</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Site of Lesion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Fibers Affected</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Field Defect</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Optic Nerve (Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ipsilateral <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">Temporal</span> + <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">Nasal</span> Fibers</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"313\" src=\"https://image.prepladder.com/content/yzlg3KBGcBkeyWrPrN7W1746515896.png\" width=\"313\"/></p>\n<p style=\"text-align:center\"><strong>Anopia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Optic <span class=\"customMeta\" data-dictid=\"e2cc97dc331692777184dee1ae5678\">Chiasma</span> (Option D ruled out)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bilateral <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">Nasal</span> Fibers</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"308\" src=\"https://image.prepladder.com/content/dYiz6vpXw8nn3hmLDVpD1746515906.png\" width=\"313\"/></p>\n<p style=\"text-align:center\"><strong>Bitemporal Hemianopia</strong></p>\n<p style=\"text-align:center\"><strong>(Heteronymous Hemianopia)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which is the condition where surgery is done to partially or completely occlude one nostril?", "options": [{"label": "A", "text": "Vasomotor rhinitis", "correct": false}, {"label": "B", "text": "Atrophic rhinitis", "correct": true}, {"label": "C", "text": "Invasive aspergillosis", "correct": false}, {"label": "D", "text": "Allergic rhinitis", "correct": false}], "correct_answer": "B. Atrophic rhinitis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following forms the lateral boundary of the anatomical snuff box?", "options": [{"label": "A", "text": "Extensor pollicis brevis and abductor pollicis longus", "correct": true}, {"label": "B", "text": "Extensor pollicis longus and abductor pollicis brevis", "correct": false}, {"label": "C", "text": "Extensor pollicis longus and extensor pollicis brevis", "correct": false}, {"label": "D", "text": "Abductor pollicis longus and abductor pollicis brevis", "correct": false}], "correct_answer": "A. Extensor pollicis brevis and abductor pollicis longus", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/1w0UzrXtXwaMRLMjwI0i1746515858.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old man presented with recurrent episodes of fever with chills. The MRCP image is shown below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Primary sclerosing cholangitis", "correct": true}, {"label": "B", "text": "Caroli disease", "correct": false}, {"label": "C", "text": "Oriental cholangitis", "correct": false}, {"label": "D", "text": "Primary biliary carcinoma", "correct": false}], "correct_answer": "A. Primary sclerosing cholangitis", "question_images": ["https://image.prepladder.com/content/W9JyjZrllfxV3MxG83fg1746515978.png"], "explanation_images": ["https://image.prepladder.com/content/kfIydjtjKGng4YGUhjnV1746516013.png", "https://image.prepladder.com/content/lgHOIDewNgZYogQcO5g21746516013.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Primary <span class=\"customMeta\" data-dictid=\"0aa16e71201692777198c4c07e2392\">Sclerosing</span> <span class=\"customMeta\" data-dictid=\"dd9fbecbed1692777184ab44e1624c\">Cholangitis</span> (PSC)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>PSC is characterised by <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and obliterative <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> of <span class=\"customMeta\" data-dictid=\"85d0636fae1692777187fc93c80934\">extrahepatic</span> and large <span class=\"customMeta\" data-dictid=\"98421c7e5e1692777190d261d75f8a\">intrahepatic</span> <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> ducts, with <span class=\"customMeta\" data-dictid=\"d141b433d2169277718681e3ff6bc3\">dilation</span> of preserved segments.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Demographics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>It commonly occurs in individuals aged 30-50 years.</li>\n<li>Has a male predominance of 2:1.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>It suggests an <strong>immunologically mediated process</strong> supported by circulating autoantibodies and T lymphocytes in the <span class=\"customMeta\" data-dictid=\"b7e71e2acf1692777195087acd2271\">periductal</span> stroma, as well as associations with<strong> HLA-B8</strong> and <strong>ulcerative colitis</strong>.</li>\n<li>A mix of <strong>environmental </strong>&amp; genetic factors may trigger <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> injury.</li>\n<li>Increased risk of PSC in first-degree relatives indicates a genetic component.</li>\n<li>Activated T cells from <span class=\"customMeta\" data-dictid=\"b118cf61a016927772018a179057ef\">ulcerative</span> <span class=\"customMeta\" data-dictid=\"e6955110f21692777184d2090a400c\">colitis</span> <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> may migrate to the liver, <span class=\"customMeta\" data-dictid=\"e4865847fa169277720044d7b530b0\">targeting</span> <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> antigens.</li>\n<li>Changes in the intestinal microbiome or infections may alter cholangiocytes, causing inflammation.</li>\n<li>Atypical <span class=\"customMeta\" data-dictid=\"2da8fc47cf169277719576cea1851f\">perinuclear</span> antineutrophil cytoplasmic antibodies (pANCA) are</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Common symptoms include fatigue, pruritus, and jaundice.</li>\n<li>Nearly 50% of patients are <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> at diagnosis, often identified through elevated <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"b95c7f7b821692777181df660ee7ff\">alkaline</span> phosphatase.</li>\n<li>Ascending cholangitis, chronic pancreatitis, and chronic <span class=\"customMeta\" data-dictid=\"180ce1a7c416927771844825c616f4\">cholecystitis</span> may also occur.</li>\n<li>Fibrosis can progress to <span class=\"customMeta\" data-dictid=\"3e6e56aa3b1692777184226d2104e4\">cirrhosis</span> over 10-15 years.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Characteristic findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>ERCP/MRCP shows the <span class=\"customMeta\" data-dictid=\"db8c3d4b9e1692777182a03a530a28\">beaded</span> appearance of <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> ducts</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Knipe H, Walizai T, Rasuli B\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/primary-sclerosing-cholangitis\" data-tags=\"\" height=\"252\" src=\"https://image.prepladder.com/content/kfIydjtjKGng4YGUhjnV1746516013.png\" width=\"305\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>Biopsy,\n\t\t\t\t<ul>\n<li>Early features:\n\t\t\t\t\t<ul>\n<li>Periductal<strong> \"onion skin\" fibrosis</strong> &amp; inflammation</li>\n<li>Portal <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> &amp; <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> ductular proliferation</li>\n</ul>\n</li>\n<li>Later stages show progressive <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> leading to <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> <span class=\"customMeta\" data-dictid=\"3e6e56aa3b1692777184226d2104e4\">cirrhosis</span> and obliterative cholangitis, resulting in <strong>\"vanishing <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> syndrome\"</strong></li>\n</ul>\n</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Raul S. Gonzalez\" data-hash=\"\" data-license=\"NA\" data-source=\"Pathology Outlines - Primary sclerosing cholangitis\" data-tags=\"\" height=\"285\" src=\"https://image.prepladder.com/content/lgHOIDewNgZYogQcO5g21746516013.png\" width=\"337\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Associated conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ulcerative colitis, risk of developing cholangiocarcinoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lifetime risk of developing <strong>cholangiocarcinoma</strong> is about 20%.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 15-year-old boy undergoes bilateral adrenalectomy for phaeochromocytoma. On the third postoperative day, the boy feels lethargic and tired. Blood pressure is 80/60 mm Hg; there is no sign of bleeding. What could be the cause of this?", "options": [{"label": "A", "text": "Addisonian crisis", "correct": true}, {"label": "B", "text": "SIADH", "correct": false}, {"label": "C", "text": "Diabetes insipidus", "correct": false}, {"label": "D", "text": "Cerebral salt wasting disease", "correct": false}], "correct_answer": "A. Addisonian crisis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented with pain in the hand. The joints involved were proximal interphalangeal (PIP) joint, distal interphalangeal (DIP) joint and first carpometacarpal joint. The wrist and metacarpophalangeal (MCP) joints were spared. What is the likely diagnosis?", "options": [{"label": "A", "text": "Osteoarthritis", "correct": true}, {"label": "B", "text": "Rheumatoid arthritis", "correct": false}, {"label": "C", "text": "Psoriatic arthritis", "correct": false}, {"label": "D", "text": "Pseudogout", "correct": false}], "correct_answer": "A. Osteoarthritis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Joint involved &amp; characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Joint spared</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Osteoarthritis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Proximal and <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">Distal</span> <span class=\"customMeta\" data-dictid=\"65604d11831692777190c5ea442405\">interphalangeal</span> joints (PIP and DIP), 1st <span class=\"customMeta\" data-dictid=\"3787fbc7ad1692777183a3b034298d\">Carpometacarpal</span> joint, Hip and knee</li>\n<li>Asymmetrical involvement</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Wrist and <span class=\"customMeta\" data-dictid=\"d7e158e089169277719265674b2879\">Metacarpophalangeal</span> (MCP) joints</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Rheumatoid arthritis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Metacarpophalangeal joint (MCP) - most commonly involved</li>\n<li>Symmetrical involvement seen</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Distal <span class=\"customMeta\" data-dictid=\"65604d11831692777190c5ea442405\">interphalangeal</span> joints (DIP) and 1st <span class=\"customMeta\" data-dictid=\"3787fbc7ad1692777183a3b034298d\">carpometacarpal</span> (CMP) joint</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Psoriatic arthritis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Proximal and <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">Distal</span> <span class=\"customMeta\" data-dictid=\"65604d11831692777190c5ea442405\">interphalangeal</span> joints (PIP and DIP)</li>\n<li>Pencil-in-cup, telescoping of digits, <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">arthritis</span> mutilans</li>\n<li>Skin and nail involvement +</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Ray pattern distribution of joints seen</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Meiosis occurs in:", "options": [{"label": "A", "text": "Adrenal", "correct": false}, {"label": "B", "text": "Adult ovary", "correct": true}, {"label": "C", "text": "Prepubertal testis", "correct": false}, {"label": "D", "text": "Hypothalamus", "correct": false}], "correct_answer": "B. Adult ovary", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/HFoSlWGZUO6qQmfo2Qz91746603631.png", "https://image.prepladder.com/content/3hATNGJXiVIFgaKleA3x1746516116.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which fibre is responsible for High-frequency vibration, pressure sensation?", "options": [{"label": "A", "text": "Pacinian corpuscles", "correct": true}, {"label": "B", "text": "Free nerve endings", "correct": false}, {"label": "C", "text": "Meissner corpuscles", "correct": false}, {"label": "D", "text": "Merkel discs", "correct": false}], "correct_answer": "A. Pacinian corpuscles", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/zyNLewT5K8480CKPMW6J1746516190.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Rapidly Adapting <span class=\"customMeta\" data-dictid=\"ff110f2cb71692777200a3483aa670\">Tactile</span> Receptors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Structure </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Function</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Location </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pacinian Corpuscle</strong><br/>\n<strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Encapsulated nerve ending</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Detect tissue <span class=\"customMeta\" data-dictid=\"316ac15070169277720221407d1017\">vibration</span> or other rapid changes in the mechanical state of tissues</strong></li>\n<li>Stimulated by rapid local <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> of the tissue</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Immediately beneath the skin and deep in the fascial tissues of the body</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Meissner Corpuscle<br/>\n\t\t\t(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elongated, <span class=\"customMeta\" data-dictid=\"e26ba9a1d41692777187d0ad03a8c1\">encapsulated</span> nerve <span class=\"customMeta\" data-dictid=\"7ae760ae1b169277718794068316b8\">ending</span> of a large <span class=\"customMeta\" data-dictid=\"dd79d3db911692777193c60304ef85\">myelinated</span> <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> nerve fiber</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Sensitive to movement of objects over the skin and low-frequency vibrations</li>\n<li>crucial for <span class=\"customMeta\" data-dictid=\"6495ef882b169277719896942b51c3\">spatial</span> location discernment of touch sensations</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Nonhairy skin, particularly abundant in fingertips and lips.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Merkel’s Disc (Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Disc-shaped expansion made up of Merkel cells and Aβ-afferent nerve endings</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Detect continuous touch and pressure,</li>\n<li>Transmit strong initial signal and weaker sustained signal,</li>\n<li>Localize touch sensations (Two point discrimination),</li>\n<li>Determine texture</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Underneath the <span class=\"customMeta\" data-dictid=\"53782f88d31692777187177cb73b24\">epithelium</span> of the skin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Free Nerve <span class=\"customMeta\" data-dictid=\"7ae760ae1b169277718794068316b8\">Ending</span> (Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Unencapsulated nerve endings</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Detect touch and pressure</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Found everywhere in skin</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented with clinical features of ataxia and incoordination. This is due to thrombosis of which artery?", "options": [{"label": "A", "text": "Posterior cerebral artery (PCA)", "correct": false}, {"label": "B", "text": "Middle cerebral artery (MCA)", "correct": false}, {"label": "C", "text": "Internal carotid artery (ICA)", "correct": false}, {"label": "D", "text": "Superior cerebellar artery (SCA)", "correct": true}], "correct_answer": "D. Superior cerebellar artery (SCA)", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/PmJBOdVdnDqS34r4sfRo1746516309.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Personal monitoring of radiation is done by:", "options": [{"label": "A", "text": "TLD badge", "correct": true}, {"label": "B", "text": "Collimators", "correct": false}, {"label": "C", "text": "Linear accelerator", "correct": false}, {"label": "D", "text": "Grid", "correct": false}], "correct_answer": "A. TLD badge", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/UIHtqRfvTST9OU8wI0lT1746516360.png", "https://image.prepladder.com/content/SRxtUkPsFMCMmPzF9ruQ1746516360.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:691px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>TLD (Thermoluminescent Dosimeter) Badge</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Purpose </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is worn by individuals in radiation-exposed environments, such as medical <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> or nuclear facilities, to track their radiation dose and ensure it stays within safe limits.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Location </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Worn<strong> beneath </strong>the lead apron (as lead apron cuts off some radiation)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Duration </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>According to the <span class=\"customMeta\" data-dictid=\"d07ff57c3f1692777182594c5f75ba\">Atomic Energy</span> Regulatory Board (AERB) of India, TLD badges are generally replaced and analyzed <strong>every 3 months</strong> to assess <span class=\"customMeta\" data-dictid=\"fa914a0d95169277718542753b513d\">cumulative</span> radiation exposure.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Composition </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Thermoluminescent phosphor crystals</strong>:</p>\n<ul>\n<li>Calcium <span class=\"customMeta\" data-dictid=\"535af9a2181692777199309af44d24\">sulfate</span> dysprosium</li>\n<li>Lithium fluoride</li>\n<li>Lithium borate</li>\n<li>Berrylium oxide</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Principle </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"600\" src=\"https://image.prepladder.com/content/UIHtqRfvTST9OU8wI0lT1746516360.png\" width=\"557\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a 50-year-old male who is a long-term smoker and experiences pain in both thighs and buttocks while walking approximately 500 meters?", "options": [{"label": "A", "text": "Arterial disease involving the superficial femoral artery", "correct": false}, {"label": "B", "text": "Arterial disease with aortoiliac involvement", "correct": true}, {"label": "C", "text": "Femoral venous insufficiency", "correct": false}, {"label": "D", "text": "Arterial disease involving the profunda femoris artery", "correct": false}], "correct_answer": "B. Arterial disease with aortoiliac involvement", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:681px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Vessels involved and common sites of <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> (in Atherosclerosis)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Vessel</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common Sites of Obstruction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Related Manifestations/Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Aorta</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Infrarenal aorta</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bilateral <span class=\"customMeta\" data-dictid=\"cbc1f41317169277719185421a8e5a\">lower limb</span> ischemia, absent <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> pulses</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Iliac arteries</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> bifurcation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Unilateral <span class=\"customMeta\" data-dictid=\"cbc1f41317169277719185421a8e5a\">lower limb</span> ischemia, absent <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> pulse.</li>\n<li>Pain in the buttock is due to a block in the common <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> or <strong>aortoiliac segment</strong> (30%), often associated with <span class=\"customMeta\" data-dictid=\"960bd9fb3d1692777189abb8d8f4cf\">impotence</span> and is called <strong>Leriche's syndrome.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Femoral artery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> artery</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Calf claudication, absent popliteal and <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> pulses</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Popliteal artery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Adductor canal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Calf and foot ischemia, absent <span class=\"customMeta\" data-dictid=\"e272cdded916927771951d2337037d\">pedal</span> pulses</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tibial arteries</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Proximal or mid-calf</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Foot ischemia, absent <span class=\"customMeta\" data-dictid=\"e272cdded916927771951d2337037d\">pedal</span> pulses</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Subclavian artery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Proximal subclavian</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Arm ischemia, absent radial/ulnar pulses.</p>\n<p><strong><u>Subclavian steal syndrome:</u></strong></p>\n<p>Obstruction of the first part of the <span class=\"customMeta\" data-dictid=\"9562c879be1692777199afcb12fa54\">subclavian</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> can cause reverse <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> through the vertebral artery, providing <span class=\"customMeta\" data-dictid=\"4de12d1ef31692777184db1d11c6bd\">collateral</span> <span class=\"customMeta\" data-dictid=\"337d16dac5169277718474b97f6e4a\">circulation</span> to the arm but affecting the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> brain and upper limb, with steal being occult, partial, or complete.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Brachial artery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mid-humerus level</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Forearm and hand ischemia, absent radial/ulnar pulses</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Respiratory distress syndrome is due to the deficiency of?", "options": [{"label": "A", "text": "Dipalmitoyl Phosphatidylcholine", "correct": true}, {"label": "B", "text": "Phosphatidylserine", "correct": false}, {"label": "C", "text": "Phosphatidylethanolamine", "correct": false}, {"label": "D", "text": "Phosphatidylinositol", "correct": false}], "correct_answer": "A. Dipalmitoyl Phosphatidylcholine", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Phospholipids </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Function</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Synthesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Significance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Phosphatidylserine </strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inner <span class=\"customMeta\" data-dictid=\"4c3d2d86ec1692777191af6eda4772\">leaflet</span> of the <strong>plasma membrane</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p>Involved in <strong>apoptosis</strong>.</p>\n</li>\n<li>\n<p>It flips to the outer <span class=\"customMeta\" data-dictid=\"4c3d2d86ec1692777191af6eda4772\">leaflet</span> of the <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> membrane, serving as a <strong>signal for phagocytes</strong> to engulf the dying cell.</p>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Synthesized in the <strong>endoplasmic <span class=\"customMeta\" data-dictid=\"1b6498ff211692777197ae0981e366\">reticulum</span> (ER)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Plays a role in <strong>blood clotting</strong> by facilitating the binding of <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> factors.</p>\n<p>Supports neuronal function.</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Phosphatidylethanolamine</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>All <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> membranes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p>Important for<strong> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> fusion</strong> and the structural integrity of <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> membranes.</p>\n</li>\n<li>\n<p>Serves as a <span class=\"customMeta\" data-dictid=\"ae13cdc5c3169277719683e9f6bda5\">precursor</span> for the <span class=\"customMeta\" data-dictid=\"3fda45538a1692777199ec2a5478a5\">synthesis</span> of phosphatidylserine.</p>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Synthesized in the <strong>ER</strong> via the <strong>cytidine diphosphate-ethanolamine (CDP-ethanolamine) pathway</strong> or by <span class=\"customMeta\" data-dictid=\"52adc3ebf01692777185395a8b1e8c\">decarboxylation</span> of <span class=\"customMeta\" data-dictid=\"ae93185bf016927771958c234af6d9\">phosphatidylserine</span> in the mitochondria.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Plays a role in <strong>lipid metabolism</strong> and <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> dynamics.</li>\n<li>Deficiencies can impact <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> functions and are associated with various neurological disorders.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Phosphatidylinositol</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>plasma <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> and <span class=\"customMeta\" data-dictid=\"a621be29da16927771901bc91014d1\">intracellular</span> membranes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p>Involved in <strong>cell <span class=\"customMeta\" data-dictid=\"f9016f36fd1692777198b0fd5e9c6d\">signaling</span> pathways</strong>, particularly through the production of <strong>secondary messengers</strong></p>\n</li>\n<li>\n<p>Plays a role in <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> <span class=\"customMeta\" data-dictid=\"4c550b1d7a1692777200641b5f4e28\">trafficking</span> and cytoskeletal organization.</p>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Produced in the <strong>ER and Golgi apparatus</strong> from CDP-DAG and inositol.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Crucial for the function of <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> <span class=\"customMeta\" data-dictid=\"f9016f36fd1692777198b0fd5e9c6d\">signaling</span> and other receptor-mediated <span class=\"customMeta\" data-dictid=\"28f5a05c8b1692777198471034364a\">signal transduction</span> pathways.</li>\n<li>Defects in <span class=\"customMeta\" data-dictid=\"26d585d1e41692777195144f4452a8\">phosphatidylinositol</span> <span class=\"customMeta\" data-dictid=\"5b1a045f5f169277719210c0ac7a1e\">metabolism</span> are <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to various diseases, including diabetes and cancer.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old woman presented with hypertension, chest pain, and cramping of the legs. A chest radiograph was taken which revealed the condition as shown in the image below. What is the likely cause of hypertension in this patient?", "options": [{"label": "A", "text": "Coarctation of aorta", "correct": true}, {"label": "B", "text": "Essential hypertension", "correct": false}, {"label": "C", "text": "Aortic aneurysm", "correct": false}, {"label": "D", "text": "Aorta-arteritis", "correct": false}], "correct_answer": "A. Coarctation of aorta", "question_images": ["https://image.prepladder.com/content/JJPwh63KmX39WlUAeTl01746516442.png"], "explanation_images": ["https://image.prepladder.com/content/ceMGJWNNWmmo6l2HIJbN1746516518.png", "https://image.prepladder.com/content/GEQZAJCVxH24xxCcsHsj1746516518.png"], "explanation": "\n<p><strong>References:</strong></p>\n<ul><li>↳ Coarctation of the aorta | Radiology Reference Article | Radiopaedia.org</li><li>↳ Grainger and Allison’s Textbook of Diagnostic Radiology, 7th edition, Page 300</li></u\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not used for the identification of the facial nerve trunk?", "options": [{"label": "A", "text": "Retrograde dissection from distal branch", "correct": false}, {"label": "B", "text": "Tragal pointer", "correct": false}, {"label": "C", "text": "Inferior belly of omohyoid muscle", "correct": true}, {"label": "D", "text": "Posterior belly of digastric", "correct": false}], "correct_answer": "C. Inferior belly of omohyoid muscle", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Ots5P2Djn6A8KM2ApWZI1746516522.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Entry into <span class=\"customMeta\" data-dictid=\"42d0553c3916927771944110a6f15b\">Parotid</span> Gland</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The main trunk enters on the <span class=\"customMeta\" data-dictid=\"b1b0b6b9c716927771966dfdac754d\">posteromedial</span> surface of the <span class=\"customMeta\" data-dictid=\"42d0553c3916927771944110a6f15b\">parotid</span> gland.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Division of Nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Divides within the gland, <strong>behind and <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> to the retromandibular <span class=\"customMeta\" data-dictid=\"75ddd4cc7016927772012e0acd424d\">vein</span> </strong>and external <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> (ECA).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Temporofacial vs. <span class=\"customMeta\" data-dictid=\"cea57afffa1692777184390211b80c\">Cervicofacial</span> Trunks</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Temporofacial trunk:</strong> Contains <strong>more axons</strong> but fewer fascicles.</li>\n</ul>\n<ul>\n<li><strong>Cervicofacial trunk:</strong> Contains <strong>more fascicles</strong> but fewer axons.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Formation of <span class=\"customMeta\" data-dictid=\"42d0553c3916927771944110a6f15b\">Parotid</span> Plexus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The trunks branch further to <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> the <span class=\"customMeta\" data-dictid=\"42d0553c3916927771944110a6f15b\">parotid</span> <span class=\"customMeta\" data-dictid=\"3a9085a5761692777195417d7c03ae\">plexus</span> (pes anserinus) from which the <span class=\"customMeta\" data-dictid=\"16b76d1d1c1692777200240efcb0e2\">terminal</span> branches arise.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Terminal Branches</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Temporal, zygomatic, buccal, marginal mandibular, and cervical.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The protein in the glomerular basement membrane responsible for charge-dependent filtration is?", "options": [{"label": "A", "text": "Fibronectin", "correct": false}, {"label": "B", "text": "Heparan sulfate", "correct": true}, {"label": "C", "text": "Collagen Type IV", "correct": false}, {"label": "D", "text": "Entactin", "correct": false}], "correct_answer": "B. Heparan sulfate", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The appearance of USG at saphenofemoral junction, showing common femoral vein, common femoral artery, and the great saphenous vein is called as:", "options": [{"label": "A", "text": "Mickey Mouse sign", "correct": true}, {"label": "B", "text": "String sign", "correct": false}, {"label": "C", "text": "Tillaux sign", "correct": false}, {"label": "D", "text": "Stamers sign", "correct": false}], "correct_answer": "A. Mickey Mouse sign", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/zNON9xL05HhMa7A1SzJR1746516677.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Radiological Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Associated Pathology</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Classic Mickey Mouse Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Refers to the appearance of <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> nerve (CN) VII and CN VIII enhancement, resembling Mickey Mouse's head.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Acoustic neuroma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Reverse Mickey Mouse Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>The reverse of the classic Mickey Mouse sign, where <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> CN V and CN VI <span class=\"customMeta\" data-dictid=\"4749be0e3f1692777187a4b4100c1d\">enhancement</span> resemble Mickey Mouse's head.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Trigeminal schwannoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Minnie Mouse Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Refers to <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> CN VII and CN VIII enhancement, resembling Minnie Mouse's head.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Facial nerve <span class=\"customMeta\" data-dictid=\"491e5b2e851692777198ba329e42ce\">schwannoma</span> or hemangioma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Mickey Mouse Ears Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Describes <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> <span class=\"customMeta\" data-dictid=\"86c230abe316927771889bbef8df5d\">globus</span> pallidus hyperintensity on brain MRI, resembling the shape of Mickey Mouse's ears.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Wilson’s disease or Carbon <span class=\"customMeta\" data-dictid=\"03077f6c8716927771923763487a9e\">monoxide</span> poisoning</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Mickey Mouse Glove Sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Characterized by symmetric <span class=\"customMeta\" data-dictid=\"a1ee14c673169277718351bfe6afd4\">calcification</span> of <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> <span class=\"customMeta\" data-dictid=\"f2804c808516927771887dda93e56c\">ganglia</span> structures on brain CT, resembling a Mickey Mouse glove.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Fahr’s syndrome or Wilson’s disease</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "C wave of JVP represents?", "options": [{"label": "A", "text": "Tricuspid bulge into right atrium during isovolumetric ventricular contraction", "correct": true}, {"label": "B", "text": "Contraction of right atrium", "correct": false}, {"label": "C", "text": "Passive filling of right atrium", "correct": false}, {"label": "D", "text": "Passive emptying of right atrium", "correct": false}], "correct_answer": "A. Tricuspid bulge into right atrium during isovolumetric ventricular contraction", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/CdOmlURhm9tL8NF5Se8W1746516863.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>a wave</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>\n<p>Caused by atrial systole<strong>. (Option B ruled out)</strong></p>\n</li>\n<li>\n<p>Atrial <span class=\"customMeta\" data-dictid=\"ca2289e348169277718516017eb2ba\">contraction</span> results in a temporary halt in <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> inflow.</p>\n</li>\n<li>\n<p>Some blood flows back into the veins, causing a rise in <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> pressure.</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>c wave</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p>Arises from the increase in atrial pressure during isovolumetric <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> contraction.</p>\n</li>\n<li>\n<p>Pressure is transmitted through the closed and bulging <span class=\"customMeta\" data-dictid=\"3ab13cdf64169277720085e2ebef1c\">tricuspid</span> valve. <strong>(Option A)</strong></p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>x descent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p>Ventricular <span class=\"customMeta\" data-dictid=\"13941ea4ec1692777199fc8cfd1a7a\">systole</span> pulls the <span class=\"customMeta\" data-dictid=\"3ab13cdf64169277720085e2ebef1c\">tricuspid</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> down</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>v wave</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p>Corresponds to the rise in atrial pressure as blood fills the atria.<strong> (Option C ruled out)</strong></p>\n</li>\n<li>\n<p>Occurs during <span class=\"customMeta\" data-dictid=\"11d448b6c4169277718635a922383c\">diastole</span> while the <span class=\"customMeta\" data-dictid=\"3ab13cdf64169277720085e2ebef1c\">tricuspid</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> is still closed.</p>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>y descent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>\n<p>Opening of <span class=\"customMeta\" data-dictid=\"3ab13cdf64169277720085e2ebef1c\">tricuspid</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> causing <span class=\"customMeta\" data-dictid=\"397f16a7a71692777187ffffefa7e6\">emptying</span> of right <span class=\"customMeta\" data-dictid=\"a8d33da8541692777182ec6983d9a2\">atrium</span> into <span class=\"customMeta\" data-dictid=\"707de303e516927772011cb80f4028\">ventricle</span> <strong>(Option D ruled out)</strong></p>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the term for the additional row of eyelashes located behind the grey line?", "options": [{"label": "A", "text": "Trichiasis", "correct": false}, {"label": "B", "text": "Distichiasis", "correct": true}, {"label": "C", "text": "Tylosis", "correct": false}, {"label": "D", "text": "Madarosis", "correct": false}], "correct_answer": "B. Distichiasis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/8qoIAkYHwY3AsVqREvlF1746516880.png", "https://image.prepladder.com/content/6L4EcmScYFMjzf5IMh111746516880.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Clinical features</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Foreign body sensation</li>\n<li>Photophobia</li>\n<li>Irritation</li>\n<li>Pain</li>\n<li>Lacrimation</li>\n<li>Reflex <span class=\"customMeta\" data-dictid=\"540b75eeb516927771831794d7ce0f\">blepharospasm</span> and <span class=\"customMeta\" data-dictid=\"46e2a1c298169277719583f46ff587\">photophobia</span> (if the <span class=\"customMeta\" data-dictid=\"4cc4d657841692777185555e1b982d\">cornea</span> is abraded)</li>\n<li>Conjunctival congestion</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Complications</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Recurrent corneal abrasions</li>\n<li>Superficial corneal opacities</li>\n<li>Corneal vascularization</li>\n</ul>\n<ul>\n<li>Non-healing corneal ulcer</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Treatment</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Epilation</li>\n<li>Electrolysis</li>\n<li>Cryoepilation</li>\n<li>Surgical correction</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A middle-aged woman presented with bilateral proptosis, restriction of eye movements, and chemosis. Her thyroid profile showed she was hyperthyroid. What is the most probable cause?", "options": [{"label": "A", "text": "Orbital pseudotumor", "correct": false}, {"label": "B", "text": "Grave’s ophthalmopathy", "correct": true}, {"label": "C", "text": "Orbital lymphoma", "correct": false}, {"label": "D", "text": "Orbital cellulitis", "correct": false}], "correct_answer": "B. Grave’s ophthalmopathy", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/r9tnTWfktKD0PX1ZEPWL1746516996.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:616px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lid Signs</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dalrymple's Sign</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Upper lid <span class=\"customMeta\" data-dictid=\"b7eab06f1a1692777197e0b50983e5\">retraction</span> causing a staring appearance (90% of cases).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Von Graefe's Sign</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lid <span class=\"customMeta\" data-dictid=\"6ef2a80e2116927771915098fa1789\">lag</span> when the globe moves downward (50% of cases).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Enroth's Sign</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Puffy, oedematous <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> of the eyelids.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gifford's Sign</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Difficulty in <span class=\"customMeta\" data-dictid=\"30ddb5b09916927771877ac72c09b7\">eversion</span> of the upper lid.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Stellwag's Sign</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Infrequent blinking.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Joffroy's Sign</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Poor forehead wrinkling on looking up.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Kocher’s sign</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased lid <span class=\"customMeta\" data-dictid=\"b7eab06f1a1692777197e0b50983e5\">retraction</span> with visual <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> (staring look)</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Conjunctival Signs</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Deep Injection</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pronounced redness.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Chemosis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Swelling of the conjunctiva.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pupillary Signs</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Less significant; may show unequal <span class=\"customMeta\" data-dictid=\"29a08d8f9216927771869ed797367e\">dilatation</span> of pupils.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ocular Motility Defects</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mobius's Sign</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Convergence weakness.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Restrictive Myopathy</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Limited movement in the direction opposite to the affected muscle.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Exophthalmos</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Both eyes are often affected with possible <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> proptosis.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which maternal antibodies do not confer substantial immunity in a newborn?", "options": [{"label": "A", "text": "Tetanus", "correct": false}, {"label": "B", "text": "Polio", "correct": true}, {"label": "C", "text": "Diphtheria", "correct": false}, {"label": "D", "text": "Measles", "correct": false}], "correct_answer": "B. Polio", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:555px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Inapparent Infection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>90-95% of cases; asymptomatic</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Abortive Poliomyelitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mild, flu-like symptoms with full recovery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Nonparalytic Poliomyelitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>More severe symptoms, including neck <span class=\"customMeta\" data-dictid=\"b52ddf2a451692777199b4d38e5c53\">stiffness</span> and pain, with a good prognosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Paralytic Poliomyelitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Includes spinal, bulbar, and <span class=\"customMeta\" data-dictid=\"7b1b23cdec1692777196fb5ec9f3f5\">polio</span> <span class=\"customMeta\" data-dictid=\"9644652a1f16927771873765457fcc\">encephalitis</span> forms, presenting with various degrees of paralysis</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The purpose of the photostress test is to distinguish between:", "options": [{"label": "A", "text": "Macula and optic nerve disease", "correct": true}, {"label": "B", "text": "Cataract and glaucoma", "correct": false}, {"label": "C", "text": "Lens and cornea", "correct": false}, {"label": "D", "text": "Retina and vitreous pathologies", "correct": false}], "correct_answer": "A. Macula and optic nerve disease", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Why is blood stored in citrate-phosphate-dextrose (CPD) preferred over acid-citrate-dextrose (ACD) for hypoxic patients?", "options": [{"label": "A", "text": "It has less P50", "correct": false}, {"label": "B", "text": "It is less acidic", "correct": false}, {"label": "C", "text": "The fall in 2,3-DPG is less", "correct": true}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "C. The fall in 2,3-DPG is less", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What would be the most appropriate course of action for the care of child Ajay, the 3-year-old brother of Anuj, who resides in the same household and received diphtheria vaccination approximately 16 months ago, while Anuj is currently undergoing treatment for diphtheria in the ward?", "options": [{"label": "A", "text": "One booster dose", "correct": false}, {"label": "B", "text": "Nothing, as the child is already exposed", "correct": false}, {"label": "C", "text": "Erythromycin + diphtheria toxoid", "correct": false}, {"label": "D", "text": "Erythromycin only", "correct": true}], "correct_answer": "D. Erythromycin only", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:616px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Diphtheria - Management of contacts</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Asymptomatic Case Contacts</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Includes household members and close contacts.</li>\n<li>Monitored for<strong> 7 days</strong> for symptoms.</li>\n<li>Prophylaxis: <strong>IM <span class=\"customMeta\" data-dictid=\"b81b3b03a21692777182c4a1cd4bbe\">benzathine penicillin</span> G</strong> (600,000 units for &lt;6 years, 1,200,000 units for ≥6 years) or 10-day <strong>oral erythromycin</strong> (40- 50 mg/kg/day, max 2 g/day).</li>\n<li>Assess and update <span class=\"customMeta\" data-dictid=\"f5f07a3262169277718915163d31e3\">immunization</span> status.</li>\n<li><strong>Booster Dose</strong>: Administer the <span class=\"customMeta\" data-dictid=\"233cc736b01692777186a2a5ac98f1\">diphtheria</span> <span class=\"customMeta\" data-dictid=\"b895bf74681692777200571d1bd203\">toxoid</span> vaccine to individuals who have not received a <span class=\"customMeta\" data-dictid=\"7725db2655169277718388f647e647\">booster</span> within the past 5 years.</li>\n<li>Vaccinate children who have <strong>not yet received</strong> their 4th dose of <span class=\"customMeta\" data-dictid=\"233cc736b01692777186a2a5ac98f1\">diphtheria</span> toxoid.</li>\n<li><strong>Incomplete or Uncertain Immunization</strong>: For those who have received fewer than 3 doses of <span class=\"customMeta\" data-dictid=\"233cc736b01692777186a2a5ac98f1\">diphtheria</span> <span class=\"customMeta\" data-dictid=\"b895bf74681692777200571d1bd203\">toxoid</span> or have an uncertain <span class=\"customMeta\" data-dictid=\"f5f07a3262169277718915163d31e3\">immunization</span> status, provide the vaccine according to the primary <span class=\"customMeta\" data-dictid=\"f5f07a3262169277718915163d31e3\">immunization</span> schedule with an age-appropriate preparation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Asymptomatic Carriers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Receive <strong>10-14 days</strong> of <span class=\"customMeta\" data-dictid=\"78d28b340916927771810a3fffeb0a\">antimicrobial</span> <span class=\"customMeta\" data-dictid=\"bc36e9b9381692777196b5f9a2f79c\">prophylaxis</span> (oral erythromycin).</li>\n<li>Administer<strong> <span class=\"customMeta\" data-dictid=\"233cc736b01692777186a2a5ac98f1\">diphtheria</span> <span class=\"customMeta\" data-dictid=\"b895bf74681692777200571d1bd203\">toxoid</span> vaccine</strong> if no <span class=\"customMeta\" data-dictid=\"7725db2655169277718388f647e647\">booster</span> has been given in the past year.</li>\n<li>Droplet precautions for <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> carriers; <span class=\"customMeta\" data-dictid=\"3cad0eb1921692777185d0a7b642fc\">contact precautions</span> for <span class=\"customMeta\" data-dictid=\"94f1c8df1f1692777185bd6a7c3fff\">cutaneous</span> carriers.</li>\n<li>Precautions continue <strong>until two negative cultures (24 hours apart) </strong>post-treatment.</li>\n<li><strong>Antitoxin is not recommended</strong> for <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> carriers.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Follow-up &amp; Repeat Cultures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Repeat cultures for cases and carriers 2 weeks post treatment.</li>\n<li>If positive, repeat a 10 day <span class=\"customMeta\" data-dictid=\"259b36252716927771879987e01054\">erythromycin</span> course and further cultures.</li>\n<li>Complete eradication is not guaranteed after one course of antibiotics.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Casual Contacts</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Routine investigation is not recommended due to low carriage rates.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hospital-Acquired Transmission</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Rare; only those with <span class=\"customMeta\" data-dictid=\"1ed9501c341692777186f4793753eb\">direct contact</span> with respiratory/oral secretions need management as contacts.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a 40-year-old patient with diabetes, a squint was observed. The secondary deviation was higher than the primary deviation during examination. The forced duction test yielded negative results. Which type of squint is expected to be predominant in this individual?", "options": [{"label": "A", "text": "Comitant squint", "correct": false}, {"label": "B", "text": "Restrictive squint", "correct": false}, {"label": "C", "text": "Paralytic squint", "correct": true}, {"label": "D", "text": "Pseudosquint", "correct": false}], "correct_answer": "C. Paralytic squint", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Where is the location of the lesion in Wernicke's hemianopic pupil?", "options": [{"label": "A", "text": "Optic nerve", "correct": false}, {"label": "B", "text": "Optic tract", "correct": true}, {"label": "C", "text": "Optic radiation", "correct": false}, {"label": "D", "text": "Optic chiasma", "correct": false}], "correct_answer": "B. Optic tract", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:735px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Reaction </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Amaurotic light reflex</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Absence of direct light <span class=\"customMeta\" data-dictid=\"20f478f55f1692777197e351415f8f\">reflex</span> on the affected side and an absence of <span class=\"customMeta\" data-dictid=\"14af60d32316927771855b142ca3ca\">consensual</span> light <span class=\"customMeta\" data-dictid=\"20f478f55f1692777197e351415f8f\">reflex</span> on the normal side.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Optic and <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> lesions</strong> on the affected side</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Efferent <span class=\"customMeta\" data-dictid=\"3aa5abc2fa169277719488e088076d\">pathway</span> defect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Absence of both direct and <span class=\"customMeta\" data-dictid=\"14af60d32316927771855b142ca3ca\">consensual</span> light <span class=\"customMeta\" data-dictid=\"20f478f55f1692777197e351415f8f\">reflex</span> on the affected side and presence of both direct and <span class=\"customMeta\" data-dictid=\"14af60d32316927771855b142ca3ca\">consensual</span> light <span class=\"customMeta\" data-dictid=\"20f478f55f1692777197e351415f8f\">reflex</span> on the normal side. Near <span class=\"customMeta\" data-dictid=\"20f478f55f1692777197e351415f8f\">reflex</span> is also absent on the affected side.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Parasympatholytic drugs (e.g. atropine, homatropine)</li>\n<li>Internal ophthalmoplegia</li>\n<li>Third-nerve paralysis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Marcus Gunn <span class=\"customMeta\" data-dictid=\"e419fd4e241692777196d038d1b71a\">pupil</span> or RAPD </strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The pupils paradoxically <span class=\"customMeta\" data-dictid=\"7e9bc153d616927771866a8608d1a5\">dilate</span> when the flashlight is swung from the unaffected to the affected eye due to the decreased light perception.</li>\n<li>It is the first sign of <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> nerve disorder.</li>\n<li>Tested by a swinging flashlight test.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Incomplete <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> nerve lesions (Optic neuritis) <strong>(Option A)</strong> and severe <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> diseases (Retinopathy, CRVO)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Adie’s Pupil</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Reaction to light is absent, and the near <span class=\"customMeta\" data-dictid=\"20f478f55f1692777197e351415f8f\">reflex</span> is very slow and tonic.</li>\n<li>It is usually unilateral, associated with absent knee <span class=\"customMeta\" data-dictid=\"b88c1802e21692777190700ee5b998\">jerk</span> and occurs more often in young women.</li>\n<li>It shows pupillary <span class=\"customMeta\" data-dictid=\"4880e9b3761692777185e64eba797c\">constriction</span> to 0.125% <span class=\"customMeta\" data-dictid=\"cad569209a16927771957ef5c7ffab\">Pilocarpine</span> due to <span class=\"customMeta\" data-dictid=\"c35382d7d61692777185a1eeeb333c\">denervation</span> supersensitivity.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Postganglionic <span class=\"customMeta\" data-dictid=\"8f19a37b5916927771941ba9f5ef49\">parasympathetic</span> <span class=\"customMeta\" data-dictid=\"c9fe973c1116927771960115521e92\">pupillomotor</span> damage.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Argyll Robertson <span class=\"customMeta\" data-dictid=\"e419fd4e241692777196d038d1b71a\">Pupil</span> (ARP)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reaction to near <span class=\"customMeta\" data-dictid=\"20f478f55f1692777197e351415f8f\">reflex</span> is present, but light <span class=\"customMeta\" data-dictid=\"20f478f55f1692777197e351415f8f\">reflex</span> (both direct and consensual) is absent, i.e. there is light near dissociation.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Neurosyphilis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Wernicke's hemianopic pupil</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Light <span class=\"customMeta\" data-dictid=\"20f478f55f1692777197e351415f8f\">reflex</span> is absent when light is thrown on the <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> half of the <span class=\"customMeta\" data-dictid=\"f17d8978bd1692777197621051012f\">retina</span> of the affected side and the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> half of the opposite side, while it is present when the light is thrown on the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> half of the affected side and the <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> half of the opposite side.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Optic <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> (Option B)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the diagnosis for a 4-year-old boy who has muscle weakness, difficulty climbing stairs, and getting up from the floor, with a muscle biopsy showing small muscle fibrils and absence of dystrophin?", "options": [{"label": "A", "text": "Becker muscle dystrophy", "correct": false}, {"label": "B", "text": "Duchenne muscular dystrophy", "correct": true}, {"label": "C", "text": "Myotonic dystrophy", "correct": false}, {"label": "D", "text": "Limb-girdle muscular dystrophy", "correct": false}], "correct_answer": "B. Duchenne muscular dystrophy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:712px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Duchenne <span class=\"customMeta\" data-dictid=\"9e2d8a3f5a16927771932c2348ec52\">Muscular</span> <span class=\"customMeta\" data-dictid=\"04568e3d19169277718672d9da94fd\">Dystrophy</span> (DMD)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Becker <span class=\"customMeta\" data-dictid=\"9e2d8a3f5a16927771932c2348ec52\">Muscular</span> <span class=\"customMeta\" data-dictid=\"04568e3d19169277718672d9da94fd\">Dystrophy</span> (BMD)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type of Mutation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Frameshift mutations</strong> leading to a disrupted reading frame</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>In frame mutations </strong>that preserve the reading frame</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dystrophin Protein</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Dystrophin deficient</li>\n<li><strong>Truncated and unstable (&lt; 3% of normal)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Abnormal <span class=\"customMeta\" data-dictid=\"4b0ac15f9316927771862866d6d51f\">dystrophin</span> </strong></li>\n<li>Partially functional (20–90% of normal)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Inheritance Pattern</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>X-linked recessive</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Age of onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Early childhood (Before 5 years)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Later childhood (After 5-7 years)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Severity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Severe, early onset, rapid progression</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Milder, later onset, slower progression</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Nonambulatory by</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>9-10.5 years of age</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt; 15 years of age</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Additional Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Early onset of myalgia, rhabdomyolysis, and <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> distress</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>None or milder</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The lining epithelium of the respiratory tract of a middle-aged man who is a chronic smoker shows a change from columnar to stratified squamous epithelium, as depicted in the image below. The change is called what?", "options": [{"label": "A", "text": "Dysplasia", "correct": false}, {"label": "B", "text": "Hypertrophy", "correct": false}, {"label": "C", "text": "Atrophy", "correct": false}, {"label": "D", "text": "Metaplasia", "correct": true}], "correct_answer": "D. Metaplasia", "question_images": ["https://image.prepladder.com/content/iYBXswRDG6pmbitvKtnw1746517229.png"], "explanation_images": ["https://image.prepladder.com/content/pxZw8dZ9pfJmFULCVRR91746517303.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/3iffP3tSI4c1c1JqJi1q1749405403.mp3", "video": ""}, {"text": "Identify the finding associated with the condition shown in the image below:", "options": [{"label": "A", "text": "Isomorphic phenomenon", "correct": true}, {"label": "B", "text": "Meyerson phenomenon", "correct": false}, {"label": "C", "text": "Gottron’s papule", "correct": false}, {"label": "D", "text": "Nikolsky’s sign", "correct": false}], "correct_answer": "A. Isomorphic phenomenon", "question_images": ["https://image.prepladder.com/content/Q3hI8hV2SDvsUotrqAaH1746517441.png"], "explanation_images": ["https://image.prepladder.com/content/PQPQZF6W1QIXupHZ13zz1746517504.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Examples</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Category 1 (True koebnerization)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Psoriasis, Lichen planus, Vitiligo</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Category 2 (Pseudo koebnerization)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Warts, Molluscum</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Category 3 (Occasional koebnerization)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Darier disease, <span class=\"customMeta\" data-dictid=\"f0f3e105661692777187df507b1f26\">Erythema</span> multiforme</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Category 4 (Dubious association with trauma)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pemphigus vulgaris, Lupus erythematosus</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Premature ageing in Werner syndrome is due to:", "options": [{"label": "A", "text": "Increased telomerase activity", "correct": false}, {"label": "B", "text": "Defects in DNA helicase", "correct": true}, {"label": "C", "text": "Increase in length of telomere due to decrease in telomerase activity", "correct": false}, {"label": "D", "text": "Decreased telomerase activity", "correct": false}], "correct_answer": "B. Defects in DNA helicase", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the morpholine drugs listed below is used as a nail lacquer?", "options": [{"label": "A", "text": "Amorolfine", "correct": true}, {"label": "B", "text": "Oxiconazole", "correct": false}, {"label": "C", "text": "Ciclopirox olamine", "correct": false}, {"label": "D", "text": "Tioconazole", "correct": false}], "correct_answer": "A. Amorolfine", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old man presented with a retroperitoneal mass. A biopsy of the lesion is shown in the image below. Molecular analysis revealed t(12;16). What is the most likely condition?", "options": [{"label": "A", "text": "Myxoid liposarcoma", "correct": true}, {"label": "B", "text": "Lipoma", "correct": false}, {"label": "C", "text": "Spindle lipoma", "correct": false}, {"label": "D", "text": "Polymorphic lipoma", "correct": false}], "correct_answer": "A. Myxoid liposarcoma", "question_images": ["https://image.prepladder.com/content/qnzVNJubWWIdc5J51sRN1746517605.png"], "explanation_images": [], "explanation": "<p>Correct Answer A - &lt;span class=\"customMeta\" data-dictid=\"58f239fc181692777193528b77cc8c\"&gt;Myxoid&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old woman presents with a lump in the upper outer quadrant of her breast. Histopathological examination of the mass shows cells in mucin pools and faint nuclei. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Colloid carcinoma", "correct": true}, {"label": "B", "text": "Papillary carcinoma", "correct": false}, {"label": "C", "text": "Medullary carcinoma", "correct": false}, {"label": "D", "text": "Lobular carcinoma", "correct": false}], "correct_answer": "A. Colloid carcinoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/t97xvO6Q2ty7v8SjUbmW1746517706.png", "https://image.prepladder.com/content/SwXBIXa69wbkssySFiwl1746517722.png", "https://image.prepladder.com/content/bDNZ7SUCsh1xNkpHLjZW1746517734.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gross <span class=\"customMeta\" data-dictid=\"54e0888a6616927771945a99208287\">pathology</span> (upper left) of biopsies of <span class=\"customMeta\" data-dictid=\"2f72b35d711692777193801d8e084d\">mucinous</span> <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> shows <span class=\"customMeta\" data-dictid=\"be6fe9c6c316927771889dbaaf2b89\">gelatinous</span> areas (which are <span class=\"customMeta\" data-dictid=\"fb59d538e21692777200b3702d4802\">transparent</span> compared to normal yellow <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> tissue). Histopathology shows clusters or nests of tumour cells floating in pools of <span class=\"customMeta\" data-dictid=\"ba366417791692777187229d34e597\">extracellular</span> mucin.</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 23-year-old male patient presented with a history of fatigue and tiredness. On investigation, he was found to have Hb = 9 g/dl and MCV = 101 FL. A peripheral smear examination showed macrocytic RBC and hypersegmented neutrophils. Which of the following is the most likely etiology?", "options": [{"label": "A", "text": "Lead poisoning", "correct": false}, {"label": "B", "text": "Iron deficiency anaemia", "correct": false}, {"label": "C", "text": "Hemolytic anemia", "correct": false}, {"label": "D", "text": "Chronic alcoholism", "correct": true}], "correct_answer": "D. Chronic alcoholism", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/okisknmyjPXiiueTcNnM1746517833.png"], "explanation": "<p>Correct Answer D - Chronic alcoh\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Folic acid Deficiency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Vitamin B12 deficiency</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Site of <span class=\"customMeta\" data-dictid=\"c66705291e1692777203ed3498a606\">folate</span> <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> - Jejunum</li>\n<li>Seen in: <strong>Alcoholics</strong>, pregnancy</li>\n<li>Causes <span class=\"customMeta\" data-dictid=\"b00388be25169277719369b3ab059f\">neural</span> tube defects</li>\n<li>Neurological symptoms are not seen</li>\n<li>Normal methylmalonic acid</li>\n<li>High homocysteine</li>\n<li>FIGLU test positive</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Site of <span class=\"customMeta\" data-dictid=\"c66705291e1692777203ed3498a606\">folate</span> <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> - Ileum</li>\n<li>Seen in: Vegetarians, pregnancy, Diphyllobothrium latum infection</li>\n<li>Neurological manifestation: Subacute combined degeneration</li>\n<li>High methylmalonic acid</li>\n<li>High homocysteine</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "How is thrombosis initiated?", "options": [{"label": "A", "text": "Platelet activation", "correct": false}, {"label": "B", "text": "Endothelial injury", "correct": true}, {"label": "C", "text": "Coagulation cascade", "correct": false}, {"label": "D", "text": "Vasoconstriction of vessels", "correct": false}], "correct_answer": "B. Endothelial injury", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 5-year-old child was admitted to the hospital with a history of prolapsing rectal mass and painless rectal bleeding. The histopathological image of the mass is shown below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Peutz-Jegher syndrome", "correct": false}, {"label": "B", "text": "Villous adenoma", "correct": false}, {"label": "C", "text": "Juvenile polyp", "correct": true}, {"label": "D", "text": "Tubular adenoma", "correct": false}], "correct_answer": "C. Juvenile polyp", "question_images": ["https://image.prepladder.com/content/OIO4esJJfcwsZQwx0k4P1746517976.png"], "explanation_images": ["https://image.prepladder.com/content/8sFldQdQt1hCjl7mTapi1746518012.png"], "explanation": "<p>Correct Answer C - &lt;span class=\"customMeta\" data-dictid=\"b5d5db1f591692777190869c6a7223\"&gt;Juvenile&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Effacement of podocyte foot processes is seen in which of the following diseases?", "options": [{"label": "A", "text": "Steroid-resistant glomerulonephritis", "correct": false}, {"label": "B", "text": "Minimal change disease", "correct": true}, {"label": "C", "text": "Rapidly progressive glomerulonephritis", "correct": false}, {"label": "D", "text": "Chronic glomerulonephritis", "correct": false}], "correct_answer": "B. Minimal change disease", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/I4CmtyCUfQcBjylPleUC1746518078.png", "https://image.prepladder.com/content/9pzFqBvf4NmJvdvm7tbi1746518094.png", "https://image.prepladder.com/content/MZBEHjufhTZPJWfMhXYT1746518127.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient who was diagnosed with ADPKD was prescribed Tolvaptan, and after a few weeks, he presented with dry mouth and increased thirst. What is the most likely cause of this presentation?", "options": [{"label": "A", "text": "Increased free water clearance", "correct": false}, {"label": "B", "text": "V2 receptor antagonism", "correct": true}, {"label": "C", "text": "Increased renal cAMP level", "correct": false}, {"label": "D", "text": "Increase in urine osmolality", "correct": false}], "correct_answer": "B. V2 receptor antagonism", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - V2 &lt;span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\"&gt;receptor&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"99de407a1516927771818ac910ab5f\"&gt;antagonism&lt;/span&gt; </p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Tolvaptan</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is a medication that belongs to a class of drugs known as <span class=\"customMeta\" data-dictid=\"699f9aa3cf1692777201b501b79deb\">vasopressin</span> <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antagonists.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>MOA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Blocks <span class=\"customMeta\" data-dictid=\"699f9aa3cf1692777201b501b79deb\">vasopressin</span> receptors, specifically <span class=\"customMeta\" data-dictid=\"e4865847fa169277720044d7b530b0\">targeting</span> the V2 receptors</p>\n<ul>\n<li>V2 receptors are located in the <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> collecting ducts</li>\n<li>Blockade of V2 receptors reduces water <span class=\"customMeta\" data-dictid=\"3086fd09371692777197a351ddde07\">reabsorption</span> and promotes the <span class=\"customMeta\" data-dictid=\"0f7653c9ef1692777187deaa35f749\">excretion</span> of free water, leading to increased <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Uses </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Syndrome of Inappropriate <span class=\"customMeta\" data-dictid=\"27bd08bbaa16927771812e98e16787\">Antidiuretic</span> Hormone <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">Secretion</span> (SIADH)</li>\n<li>Autosomal Dominant <span class=\"customMeta\" data-dictid=\"ba336eb30516927771960f9d9bd85c\">Polycystic</span> <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">Kidney</span> Disease (ADPKD)</li>\n<li>Hyponatremia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Side effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Polyuria and polydipsia</li>\n<li>Dehydration</li>\n<li>Dry mouth</li>\n<li>Hypersensitivity reactions</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Contraindications </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hypersensitivity</li>\n<li>Concurrent use of CYP3A inhibitors - Ketoconazole, Clarithromycin</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Precautions </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Monitor <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> sodium levels - adjust dose accordingly</li>\n<li>Use with caution in patients with <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> diseases</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Based on the graph given below shows the relationship between the log dose and the response of Drugs A, B and C. Which of the following has the highest potency?", "options": [{"label": "A", "text": "A", "correct": true}, {"label": "B", "text": "B", "correct": false}, {"label": "C", "text": "Both A and B", "correct": false}, {"label": "D", "text": "C", "correct": false}], "correct_answer": "A. A", "question_images": ["https://image.prepladder.com/content/Kk4XfNLqeYmtXI457YZZ1746518904.png"], "explanation_images": [], "explanation": "<p>Correct Answer A - A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a prokinetic?", "options": [{"label": "A", "text": "5-HT4 agonist", "correct": false}, {"label": "B", "text": "Dopamine antagonist", "correct": false}, {"label": "C", "text": "Motilin agonist", "correct": false}, {"label": "D", "text": "Diphenylmethane", "correct": true}], "correct_answer": "D. Diphenylmethane", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - Diphenylmethane</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Prokinetic</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Prokinetic agents are medications that enhance <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> <span class=\"customMeta\" data-dictid=\"c8c1db40c9169277719258df1a6b43\">motility</span> and promote the movement of food through the <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> tract.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Drugs </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>5-HT<sub>4</sub> agonist</strong> - stimulates 5-HT<sub>4</sub> in the GIT, which causes increased release of <span class=\"customMeta\" data-dictid=\"a79a62c36e169277718062f9630d56\">Acetylcholine</span> and enhances GIT motility</p>\n<ul>\n<li><strong>Naronapride</strong></li>\n<li><strong>Cisapride </strong></li>\n<li><strong>Prucalopride </strong></li>\n</ul>\n<p><strong>Dopamine <span class=\"customMeta\" data-dictid=\"2e432a4f3c1692777181e8e244ca0e\">antagonist</span> - </strong>blocks <span class=\"customMeta\" data-dictid=\"9194a239ed1692777186bfe41c0e87\">dopamine</span> receptors in the GIT, which reduces the <span class=\"customMeta\" data-dictid=\"1b6bd49bf11692777190214aa47f99\">inhibitory</span> effects of <span class=\"customMeta\" data-dictid=\"9194a239ed1692777186bfe41c0e87\">dopamine</span> on the GIT motility.</p>\n<ul>\n<li><strong>Metocloprimde </strong></li>\n<li><strong>Domperidone </strong></li>\n</ul>\n<p><strong>Motilin <span class=\"customMeta\" data-dictid=\"7d8d28cda71692777180c89a3c86ce\">agonist</span> - </strong> Mimics the action of motilin, which promotes GIT motility</p>\n<ul>\n<li><strong>Erythromycin </strong>(Off-label)</li>\n<li><strong>Camicinal</strong></li>\n</ul>\n<p><strong>Miscellaneous </strong></p>\n<ul>\n<li><strong>Sincalide</strong> - <span class=\"customMeta\" data-dictid=\"f64846f7ea16927771835e864b62e7\">C-terminal</span> <span class=\"customMeta\" data-dictid=\"16c05c3596169277719419d79fd5e8\">octapeptide</span> of CCK</li>\n<li><strong>Relamorelin</strong> - <span class=\"customMeta\" data-dictid=\"fd5e44e39e16927771889e55274ff1\">Ghrelin</span> agonist</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Gastrointestinal <span class=\"customMeta\" data-dictid=\"def94cc96d16927771970d1a5cfb71\">reflux</span> disease</li>\n<li>Gastroparesis</li>\n<li>Functional dyspepsia</li>\n<li>Postoperative ileus</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Adverse effects </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Gastrointestinal <span class=\"customMeta\" data-dictid=\"4586eccbe71692777186e577e31829\">disturbance</span> (Diarrhoea, Vomiting, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> cramps)</li>\n<li>Headache</li>\n<li>Dizziness</li>\n<li>Extrapyramidal symptoms with <span class=\"customMeta\" data-dictid=\"9194a239ed1692777186bfe41c0e87\">Dopamine</span> antagonist</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following antiarrhythmic drugs is contraindicated in a patient with interstitial lung disease?", "options": [{"label": "A", "text": "Amiodarone", "correct": true}, {"label": "B", "text": "Sotalol", "correct": false}, {"label": "C", "text": "Quinidine", "correct": false}, {"label": "D", "text": "Lignocaine", "correct": false}], "correct_answer": "A. Amiodarone", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - Amiodarone</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Drugs </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Lung disorders </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Amniodarone </strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p> </p>\n<p>Pulmonary fibrosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Bleomycin </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Busulfan</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Nitrofurantoin </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rarely associated with chronic <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> fibrosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cyclophosphamide </strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p>Interstitial pneumonitis, which can lead to <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> fibrosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Methotrexate </strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 308 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 200 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Beta 2 receptor action leading to hyperglycemia/hypoglycemia is mediated by which of the following enzymes?", "options": [{"label": "A", "text": "Adenylyl cyclase", "correct": true}, {"label": "B", "text": "Guanylyl cyclase", "correct": false}, {"label": "C", "text": "Phospholipase C", "correct": false}, {"label": "D", "text": "Phospholipase A2", "correct": false}], "correct_answer": "A. Adenylyl cyclase", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pathway</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mechanism</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>cAMP/PKA Pathway</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Activation of β2-AR by catecholamines or β2-agonists couples with Gs protein.Increases cAMP and activates PKA.PKA phosphorylates proteins regulating <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> metabolism.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>mTORC2 Pathway</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chronic β2-AR <span class=\"customMeta\" data-dictid=\"7f3792072b1692777199fd8e2c4f59\">stimulation</span> promotes <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> <span class=\"customMeta\" data-dictid=\"cc20d2d7111692777201fb0caeb3f2\">uptake</span> via mTORC2.Enhances GLUT4 <span class=\"customMeta\" data-dictid=\"8ba7332e86169277720060bd4507c8\">translocation</span> to the muscle cell membrane, independent of <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> signaling.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Effect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mechanism</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hyperglycemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acute β2-AR <span class=\"customMeta\" data-dictid=\"7f3792072b1692777199fd8e2c4f59\">stimulation</span> increases blood <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> levels.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Promotes <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> <span class=\"customMeta\" data-dictid=\"0e0596a13f169277718805afad1bcb\">glycogenolysis</span> and gluconeogenesis.Stimulates <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> from <span class=\"customMeta\" data-dictid=\"806eb8418c16927771822855b56695\">beta</span> cells.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypoglycemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chronic β2-AR <span class=\"customMeta\" data-dictid=\"7f3792072b1692777199fd8e2c4f59\">stimulation</span> lowers blood <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> levels.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increases skeletal muscle <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> <span class=\"customMeta\" data-dictid=\"cc20d2d7111692777201fb0caeb3f2\">uptake</span> via mTORC2-mediated GLUT4 translocation.Improves <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> tolerance.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Counterregulatory Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Restores <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> during <span class=\"customMeta\" data-dictid=\"78c658d4ed1692777189098c7544b9\">hypoglycemia</span> or fasting.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Stimulates <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> production.Inhibits <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> action in <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> tissues.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child with loose stools for one day presented to your OPD. On examination, signs of dehydration were present and the child was given ORS. It facilitates glucose absorption through which of the following receptors?", "options": [{"label": "A", "text": "SGLT 1", "correct": true}, {"label": "B", "text": "SGLT 2", "correct": false}, {"label": "C", "text": "GLUT 4", "correct": false}, {"label": "D", "text": "Na-Ca transporter", "correct": false}], "correct_answer": "A. SGLT 1", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Glucose Transporter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Function</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>GLUT 1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Various tissues, including brain, erythrocytes, and placenta</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Basal <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> <span class=\"customMeta\" data-dictid=\"cc20d2d7111692777201fb0caeb3f2\">uptake</span> in various tissues (constitutive <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> transporter)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>GLUT 2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Liver, pancreatic <span class=\"customMeta\" data-dictid=\"806eb8418c16927771822855b56695\">beta</span> cells, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> tubules, small intestine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Facilitates bidirectional <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> transport in liver, pancreatic <span class=\"customMeta\" data-dictid=\"806eb8418c16927771822855b56695\">beta</span> cells, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> tubules, and small intestine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>GLUT 3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Brain, placenta, testes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Facilitates high-affinity <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> <span class=\"customMeta\" data-dictid=\"cc20d2d7111692777201fb0caeb3f2\">uptake</span> in neurons and other <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> dependent cells</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>GLUT 4 </strong><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Adipose tissue, skeletal muscle</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Insulin-regulated <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> transporter. Facilitates <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> <span class=\"customMeta\" data-dictid=\"cc20d2d7111692777201fb0caeb3f2\">uptake</span> in response to insulin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>GLUT 5</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Small intestine, testes, kidney, <span class=\"customMeta\" data-dictid=\"5c2a4a949d16927771802ba54640cc\">adipose</span> tissue, skeletal muscle</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Facilitates <span class=\"customMeta\" data-dictid=\"d5bac53d50169277720363f48a6b3a\">fructose</span> transport (also transports <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> to a lesser extent)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>SGLT 1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Small intestine, kidney</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sodium-dependent <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> cotransporter. Facilitates active <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> in the small intestine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>SGLT 2 </strong><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Kidney</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sodium-dependent <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> cotransporter. Facilitates <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> <span class=\"customMeta\" data-dictid=\"3086fd09371692777197a351ddde07\">reabsorption</span> in the kidneys</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Calculate the sodium deficit in a 30-year-old man weighing 70 kg with a sodium level of 120 mEq/L.", "options": [{"label": "A", "text": "280 mEq", "correct": false}, {"label": "B", "text": "480 mEq", "correct": false}, {"label": "C", "text": "840 mEq", "correct": true}, {"label": "D", "text": "1400 mEq", "correct": false}], "correct_answer": "C. 840 mEq", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Factor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Value</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Desired Sodium</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>140 mEq/L</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Current Sodium</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>120 mEq/L</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>TBW for Male (70kg)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>42 L</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sodium Deficit</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>840 mEq</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A body fluid sample is being studied with Na: 10 mEq/L, K: 140 mEq/L, Cl: 4 mEq/L. Identify the compartment from which the fluid has been obtained.", "options": [{"label": "A", "text": "Interstitial", "correct": false}, {"label": "B", "text": "Intracellular fluid", "correct": true}, {"label": "C", "text": "Extracellular fluid", "correct": false}, {"label": "D", "text": "Plasma", "correct": false}], "correct_answer": "B. Intracellular fluid", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fluid Compartment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Na<sup>+</sup> (mEq/L)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>K<sup>+</sup> (mEq/L)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Ca<sup>2+</sup> (mEq/L)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cl<sup>-</sup> (mEq/L)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Protein (g/L)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Glucose (mg/dL)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>pH</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Intracellular Fluid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10-20</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>140-150</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;0.0002</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>100</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>7.3-7.5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Extracellular Fluid (Plasma) </strong><strong>(Options C&amp; D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>135-145</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3.5-5.5</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1.3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>95-105</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>60-80</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>100</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>7.4</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Extracellular Fluid (Interstitial) </strong><strong>(Options A &amp; C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>135-145</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4.0</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1.2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>100-115</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>~2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>100</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>~7.4</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which cells are impacted in multiple sclerosis?", "options": [{"label": "A", "text": "Microglia", "correct": false}, {"label": "B", "text": "Oligodendrocytes", "correct": true}, {"label": "C", "text": "Astrocytes", "correct": false}, {"label": "D", "text": "Ependymal cells", "correct": false}], "correct_answer": "B. Oligodendrocytes", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable diagnosis for a 20-year-old male patient who has been experiencing lower backache and morning stiffness for two years, along with bilateral heel pain for the past six months?", "options": [{"label": "A", "text": "Tuberculosis of the spine", "correct": false}, {"label": "B", "text": "Ankylosing spondylitis", "correct": true}, {"label": "C", "text": "Disc prolapse", "correct": false}, {"label": "D", "text": "Mechanical pain", "correct": false}], "correct_answer": "B. Ankylosing spondylitis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/dT3Dlav3TZBgvdRf6XFW1745392147.png", "https://image.prepladder.com/notes/1VjPOmAl9ZtHztRlOhIV1746427586.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chronic <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> disease primarily affecting the <span class=\"customMeta\" data-dictid=\"01591f7f591692777182ef8aa2360c\">axial</span> <span class=\"customMeta\" data-dictid=\"70f596ae8f16927771983211d9e56f\">skeleton</span> (spine and <span class=\"customMeta\" data-dictid=\"1e5164b7d61692777198fcbb77e4ad\">sacroiliac</span> joints), leading to pain, stiffness, and <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> fusion<strong> (bamboo spine)</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Idiopathic; genetic (HLA-B27) and environmental factors involved. HLA-B27 is positive in 90% of cases, but not all carriers develop AS.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inflammation at entheses → Erosive changes → New bone formation → Syndesmophytes → <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">Spinal</span> <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> (ankylosis).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Musculoskeletal Symptoms:</strong></p>\n<ul>\n<li>Chronic low back pain (worse after inactivity, better with activity)</li>\n<li>Limited <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> mobility</li>\n<li>Enthesitis (Achilles, <span class=\"customMeta\" data-dictid=\"a7a430f3a9169277719510c13f434d\">plantar</span> fascia)</li>\n<li>Peripheral <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">arthritis</span> (hips, shoulders, knees)</li>\n</ul>\n<p><strong>Extra-articular Symptoms:</strong></p>\n<ul>\n<li><strong>Ocular:</strong> Anterior <span class=\"customMeta\" data-dictid=\"b07d6fd6ef1692777201015472cd79\">uveitis</span> (pain, redness, photophobia)</li>\n<li><strong>Cardiovascular:</strong> Aortic regurgitation, <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> issues</li>\n<li><strong>Pulmonary: </strong>Apical fibrosis</li>\n<li><strong>Gastrointestinal:</strong> Associated with IBD</li>\n</ul>\n<p><strong>Clinical tests:</strong></p>\n<ul>\n<li><strong>Schober/ Modified Schober test (for <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">lumbar</span> spine)</strong></li>\n<li>Gaenslen’s test</li>\n<li>Patrick/FABER test</li>\n<li>Figure of 4 test</li>\n<li>Pump handle test</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Based on clinical features, <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> studies, and HLA-B27 gene presence. <strong>Modified New York Criteria:</strong></p>\n<p><strong>Clinical Criteria:</strong></p>\n<ul>\n<li>Low back pain &gt; 3 months (improves with exercise, not with rest)</li>\n<li>Limited <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">lumbar</span> spine motion (sagittal/frontal planes)</li>\n<li>Reduced chest expansion (relative to age/sex)</li>\n</ul>\n<p><strong>Radiographic Criteria (X-ray):</strong></p>\n<ul>\n<li>Bilateral <span class=\"customMeta\" data-dictid=\"d17a3a17bc16927771988d9f2533a8\">sacroiliitis</span> (grade 2-4) or <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> <span class=\"customMeta\" data-dictid=\"d17a3a17bc16927771988d9f2533a8\">sacroiliitis</span> (grade 3-4)</li>\n</ul>\n<p><strong>Radiological Features:</strong></p>\n<ul>\n<li>Blurring/haziness of <span class=\"customMeta\" data-dictid=\"1e5164b7d61692777198fcbb77e4ad\">sacroiliac</span> joint</li>\n<li>Squaring of vertebrae</li>\n<li><strong>Bamboo spine</strong></li>\n<li><strong>Dagger sign</strong></li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"377\" src=\"https://image.prepladder.com/content/dT3Dlav3TZBgvdRf6XFW1745392147.png\" width=\"377\"/></p>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Bamboo Spine vs Dagger Spine\" data-author=\"Lara Sammut, N.Bonanno, R.Grech, A.Mizzi\" data-hash=\"11711\" data-license=\"NA\" data-source=\"https://www.semanticscholar.org/paper/Cornered!-A-pictorial-review-of-the-radiological-in-Sammut-Bonanno/1c9e557c1a500c3ed3e202e5c15b0e4bc7e5db29/figure/4\" data-tags=\"AlkalylosingSpondylosis,SpineAbnormalities\" height=\"378\" src=\"https://image.prepladder.com/notes/1VjPOmAl9ZtHztRlOhIV1746427586.png\" width=\"378\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>MRI:</strong> Early <span class=\"customMeta\" data-dictid=\"723fdec66b1692777186e92f0c6fdf\">detection</span> of inflammation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Laboratory Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>HLA-B27 positive (90% of cases)</li>\n<li>ESR, CRP: Elevated during active disease, but can be normal</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Non-Pharmacological:</strong></p>\n<ul>\n<li>Physical therapy (mobility/posture exercises)</li>\n<li>Patient education on disease and exercise importance</li>\n</ul>\n<p><strong>Pharmacological:</strong></p>\n<ul>\n<li>NSAIDs (first-line for pain, stiffness)</li>\n<li>TNF inhibitors/IL-17 inhibitors (Secukinumab)</li>\n<li>Sulfasalazine (for <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> arthritis)</li>\n<li>Corticosteroids (short-term <span class=\"customMeta\" data-dictid=\"68e7440bd91692777202d8a14c33e0\">flare</span> control)</li>\n</ul>\n<p><strong>Surgical:</strong></p>\n<ul>\n<li>Hip replacement (for severe hip involvement)</li>\n<li>Spinal surgery (for severe deformities/fractures)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Spinal fractures (minimal trauma)</li>\n<li>Cardiac issues (aortic regurgitation, <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> defects)</li>\n<li>Osteoporosis leading to <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> risk</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a 5-year-old child who visited the pediatrician due to bilateral knee joint pain, normal bone mineral density, and the provided X-ray image of the joints?", "options": [{"label": "A", "text": "Scurvy", "correct": true}, {"label": "B", "text": "Rickets", "correct": false}, {"label": "C", "text": "Metaphyseal dysplasia", "correct": false}, {"label": "D", "text": "Pycnodysostosis", "correct": false}], "correct_answer": "A. Scurvy", "question_images": ["https://image.prepladder.com/content/B7C2143MoaQtKnlJWtR61745392381.png"], "explanation_images": ["https://image.prepladder.com/notes/MkMHu69rTgXSnZolqExr1746427969.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The following test is done to assess?", "options": [{"label": "A", "text": "Posterior interosseous nerve", "correct": false}, {"label": "B", "text": "Ulnar nerve", "correct": false}, {"label": "C", "text": "Musculocutaneous nerve", "correct": false}, {"label": "D", "text": "Median nerve", "correct": true}], "correct_answer": "D. Median nerve", "question_images": ["https://image.prepladder.com/content/tdwyY2FmRLj2QxOWaQca1745392685.png"], "explanation_images": ["https://image.prepladder.com/content/vN65lwmFTVuS7cZhowHX1745392771.png", "https://image.prepladder.com/content/H9HCl7bxXJwRRS3HGHbG1745392810.png", "https://image.prepladder.com/content/270i4ZbXqaeXfLP54s5J1745392844.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Muscle tested and action</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pen test:</strong></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"213\" src=\"https://image.prepladder.com/content/vN65lwmFTVuS7cZhowHX1745392771.png\" width=\"212\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Muscle:</strong> <span class=\"customMeta\" data-dictid=\"1a19c0413216927771801f371db10e\">Abductor</span> pollicis brevis <strong>(Option C)</strong></li>\n<li><strong>Action:</strong> <span class=\"customMeta\" data-dictid=\"69ae073b9f169277718021ae773099\">Abduction</span> of thumb</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Oschner <span class=\"customMeta\" data-dictid=\"7d9fedb3a5169277718426c475e8e8\">clasp</span> test:</strong></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"229\" src=\"https://image.prepladder.com/content/H9HCl7bxXJwRRS3HGHbG1745392810.png\" width=\"228\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Muscle:</strong> <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">Flexor</span> digitorum <span class=\"customMeta\" data-dictid=\"d3c34e683916927771998a3426c3a6\">superficialis</span> &amp; <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">flexor</span> digitorum profundus</li>\n<li><strong>Action:</strong> <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">Flexion</span> of <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> 2 digits</li>\n<li><strong>Pointing index</strong> sign seen.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Thumb opposition:</strong></p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"223\" src=\"https://image.prepladder.com/content/270i4ZbXqaeXfLP54s5J1745392844.png\" width=\"222\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Muscle:</strong> <span class=\"customMeta\" data-dictid=\"b2e2ebbf311692777194cb8034cba4\">Opponens</span> pollcis</li>\n<li><strong>Action: </strong>Opposition of thumb</li>\n<li><strong>O-sign</strong> is seen in normal patients</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 10-year-old boy, presented with a mild painful swelling over the scalp since 3 months, as depicted below. Additionally, the patient confirms having a pet dog in his household. What is the most appropriate diagnosis of this condition?", "options": [{"label": "A", "text": "Furuncle", "correct": false}, {"label": "B", "text": "Epidermoid cyst", "correct": false}, {"label": "C", "text": "Kerion", "correct": true}, {"label": "D", "text": "Folliculitis", "correct": false}], "correct_answer": "C. Kerion", "question_images": ["https://image.prepladder.com/notes/wV8UQaXBKRSVKJYmlWsl1746428399.png"], "explanation_images": ["https://image.prepladder.com/notes/wV8UQaXBKRSVKJYmlWsl1746428399.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Kerion (Inflammatory <span class=\"customMeta\" data-dictid=\"dbb566df9216927772009e22e9d078\">Tinea</span> Capitis)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Non-inflammatory <span class=\"customMeta\" data-dictid=\"dbb566df9216927772009e22e9d078\">Tinea</span> Capitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Zoophilic <span class=\"customMeta\" data-dictid=\"5ab0081e8316927772037e0f7c5a79\">fungi</span> (Microsporum canis, Trichophyton mentagrophytes)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anthropophilic <span class=\"customMeta\" data-dictid=\"5ab0081e8316927772037e0f7c5a79\">fungi</span> (Trichophyton tonsurans)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Boggy, <strong>pustular</strong>, <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> swelling</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dry, <span class=\"customMeta\" data-dictid=\"a37fd1603c1692777198f87a4a51dc\">scaly</span> <strong>patches</strong> with <strong>black dots</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hair loss</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Yes, <strong>scarring alopecia</strong> if untreated</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Yes, but <strong>non-scarring</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pain/Discharge</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Painful</strong>, pus-filled lesions</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Painless, <strong>no pus</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>KOH mount, Wood’s lamp (fluoresces with Microsporum)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>KOH mount, culture</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Oral <span class=\"customMeta\" data-dictid=\"4c8eb4d8aa16927771882300fb0a01\">griseofulvin</span> or terbinafine</strong>, <span class=\"customMeta\" data-dictid=\"9c5b45e3b916927772000167f2669a\">topical</span> antifungals</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Oral antifungals</strong>, <span class=\"customMeta\" data-dictid=\"03e69ce4341692777190edbcfbb900\">ketoconazole</span> shampoo</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year old male with gradual progressive swelling around his wrist joint for 3 months. Image of the swelling on the x-ray film is given below. What is the probable diagnosis?", "options": [{"label": "A", "text": "Osteosarcoma", "correct": false}, {"label": "B", "text": "Ewing’s Sarcoma", "correct": false}, {"label": "C", "text": "Osteoclastoma", "correct": true}, {"label": "D", "text": "Osteochondroma", "correct": false}], "correct_answer": "C. Osteoclastoma", "question_images": ["https://image.prepladder.com/notes/3gcY2kPhmAPVniJ7WvLu1746428642.png", "https://image.prepladder.com/notes/TXx3y0LyhucorOcNL99E1746428681.png"], "explanation_images": ["https://image.prepladder.com/notes/3gcY2kPhmAPVniJ7WvLu1746428642.png", "https://image.prepladder.com/notes/TXx3y0LyhucorOcNL99E1746428681.png", "https://image.prepladder.com/notes/ZEqUMY4SZ8trCmid1Kim1746428967.png", "https://image.prepladder.com/content/LSwWBCFJDKLpX6E2gSjq1745393240.png", "https://image.prepladder.com/content/z10Lst7mwjM9H8EqWQKo1745393273.png", "https://image.prepladder.com/content/8iIvWKjTdLoMzltOy8oN1745393309.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Benign but locally aggressive tumor of bone.<strong> </strong></li>\n<li>It commonly arises from epiphysis.</li>\n<li>MC Age: 20 and 45 years of age.</li>\n<li>Females &gt; males.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sites affected</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Distal <span class=\"customMeta\" data-dictid=\"512283ec9816927772024c89478b7d\">femur</span> &gt; <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> <span class=\"customMeta\" data-dictid=\"ca6af868811692777200ce067e9db9\">tibia</span> &gt; <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"ec7c10c0421692777197d151a4c0b5\">radius</span> &gt; sacrum.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Malignancy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Malignant transformation in &lt;1% of cases.</li>\n<li>Lungs are the most common site for metastases.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Swelling, vague pain.</li>\n<li>Pathological fracture.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Osteoclastoma\" data-author=\"Raveenthiran Venkatachalam, Vincent Mangayarkarasi, Murugesan Kousalya, Periyaswamy Viswanathan, Manivachagam Dhanalakshmi, Viswanathan Anandi\" data-hash=\"11723\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/Subcutaneous-Entomophthoromycosis-of-the-right-wrist-mimicking-osteoclastoma_fig3_273785875\" data-tags=\"May2025\" height=\"254\" src=\"https://image.prepladder.com/notes/3gcY2kPhmAPVniJ7WvLu1746428642.png\" width=\"200\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>X-ray: Expansile <span class=\"customMeta\" data-dictid=\"897ef2d27c16927771861eb7f4726c\">eccentric</span> <span class=\"customMeta\" data-dictid=\"d54da38aaa1692777191560f60c0f9\">lytic</span> <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> on epiphysis</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Osteoclastoma - Xray\" data-author=\"Amini B, MacManus D, Le L, et al.\" data-hash=\"11726\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/giant-cell-tumour-of-bone\" data-tags=\"May2025\" height=\"261\" src=\"https://image.prepladder.com/notes/TXx3y0LyhucorOcNL99E1746428681.png\" width=\"200\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histo- pathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Multinucleated giant cells and a background network of spindle-shaped <span class=\"customMeta\" data-dictid=\"81ec3329d0169277719261f4b61d44\">mononuclear</span> stromal cells.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Osteoclastoma Histopathology\" data-author=\"Nephron\" data-hash=\"11730\" data-license=\"CC-BY-SA-3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Giant_cell_tumour_of_bone_-_very_high_mag.jpg\" data-tags=\"May2025\" height=\"212\" src=\"https://image.prepladder.com/notes/ZEqUMY4SZ8trCmid1Kim1746428967.png\" width=\"316\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Extended <span class=\"customMeta\" data-dictid=\"f857ee35331692777185a5895e53b5\">curettage</span> with Bone grafting</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child with a history of night-blindness presented to you with the following findings. What is the diagnosis?", "options": [{"label": "A", "text": "Phrynoderma", "correct": true}, {"label": "B", "text": "Keratosis pilaris", "correct": false}, {"label": "C", "text": "Darier disease", "correct": false}, {"label": "D", "text": "Follicular eczema", "correct": false}], "correct_answer": "A. Phrynoderma", "question_images": ["https://image.prepladder.com/content/9VEAjRDXurbFvsKgerip1745393372.png"], "explanation_images": ["https://image.prepladder.com/content/9VEAjRDXurbFvsKgerip1745393372.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Follicular <span class=\"customMeta\" data-dictid=\"fc203fa4cb1692777189d4212b9366\">hyperkeratosis</span> due to Vitamin A deficiency</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Malnutrition, fat malabsorption, chronic diarrhea</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Keratotic papules on <span class=\"customMeta\" data-dictid=\"45f9bc42ac16927771871c9dc2970a\">extensor</span> surfaces, rough skin, night blindness</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clinical, <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> Vitamin A levels</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vitamin A supplementation, improved nutrition</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a patient who is brought to the hospital after a road traffic accident, complaining of pain around the left hip joint, and is found to have a flexed, adducted, and internally rotated affected limb with noticeable shortening?", "options": [{"label": "A", "text": "Anterior hip dislocation", "correct": false}, {"label": "B", "text": "Posterior hip dislocation", "correct": true}, {"label": "C", "text": "Central fracture dislocation of hip", "correct": false}, {"label": "D", "text": "Intertrochanteric fracture", "correct": false}], "correct_answer": "B. Posterior hip dislocation", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/193kUOlziSZFGOih3sZ81745393575.png", "https://image.prepladder.com/notes/FJ4eQV2ezpZkhr9p769C1746429431.png", "https://image.prepladder.com/notes/yG0XhhUfUiGBtlgXURRF1746429608.png", "https://image.prepladder.com/notes/2r8NQycTvGROX6xqAMo61746429632.png", "https://image.prepladder.com/notes/rT2uaJzChN8SkicIU7aK1746429672.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Posterior <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of hip </strong><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Anterior <span class=\"customMeta\" data-dictid=\"c1aae6e67f169277718624a4e51cfe\">dislocation</span> of hip </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Central <span class=\"customMeta\" data-dictid=\"1954a47dd6169277720351aed9c4c0\">fracture-dislocation</span> of hip </strong><strong>(Option C) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of injury:</strong></p>\n<ul>\n<li>Caused by force along the <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> <span class=\"customMeta\" data-dictid=\"665018e7801692777198b82c6c9db8\">shaft</span> with the hip flexed (e.g., <strong>dashboard injury </strong>in motor accidents).</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of injury:</strong></p>\n<ul>\n<li>Rare injury that occurs with forced <span class=\"customMeta\" data-dictid=\"69ae073b9f169277718021ae773099\">abduction</span> and external rotation.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of injury: </strong></p>\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head is driven through the <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> wall of the <span class=\"customMeta\" data-dictid=\"58112da05c1692777180028ce828fa\">acetabulum</span> into the <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> cavity.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features:</strong></p>\n<ul>\n<li>History of trauma.</li>\n<li>Pain, swelling.</li>\n<li>Deformity: <strong>flexion</strong>, <strong>adduction</strong>, <strong>internal rotation</strong>.</li>\n<li><strong>Shortening </strong>of the leg.</li>\n<li><strong>Femoral head is </strong>palpable in the <strong>gluteal </strong>region.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features: </strong></p>\n<ul>\n<li>The limb appears <strong>externally rotated.</strong></li>\n<li>Possible <strong>lengthening </strong><strong>of the affected limb </strong></li>\n<li><strong>The <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> head </strong>is <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> in the <strong>groin</strong>.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features:</strong></p>\n<ul>\n<li>Varying <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> is seen.</li>\n<li>Joint <span class=\"customMeta\" data-dictid=\"b52ddf2a451692777199b4d38e5c53\">stiffness</span> and <span class=\"customMeta\" data-dictid=\"720567fecd169277719411dda3d1a2\">osteoarthritis</span> are very likely.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"P Sanjay, N Prasad, S Raman, A Kamal\" data-hash=\"\" data-license=\"NA\" data-source=\"https://ispub.com/IJEM/1/2/4360\" data-tags=\"\" height=\"196\" src=\"https://image.prepladder.com/content/193kUOlziSZFGOih3sZ81745393575.png\" width=\"203\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Anterior hip dislocation \" data-author=\"Mayur Nayak, Rahul Yadav, Binay K. Sahu, Venkatesan S. Kumar, Vijay Sharma\" data-hash=\"11734\" data-license=\"CC BY\" data-source=\"https://www.cureus.com/articles/18111-an-unusual-presentation-of-pubic-type-anterior-hip-dislocation-with-concomitant-anterior-and-posterior-acetabular-wall-fracture#!/\" data-tags=\"May2025\" height=\"100\" src=\"https://image.prepladder.com/notes/FJ4eQV2ezpZkhr9p769C1746429431.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Posterior dislocation of the hip\" data-author=\"James Heilman, MD\" data-hash=\"11735\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Hip_dislocation#/media/File:HipdisX.png\" data-tags=\"May2025\" height=\"270\" src=\"https://image.prepladder.com/notes/yG0XhhUfUiGBtlgXURRF1746429608.png\" width=\"184\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Anterior hip dislocation \" data-author=\"Lorenzo Ceri, Luigi Zanna, Roberto Buzzi, Pietro De Biase\" data-hash=\"11736\" data-license=\"CC BY NC ND 4.0\" data-source=\"https://www.sciencedirect.com/science/article/pii/S235264402100056X?via%3Dihub\" data-tags=\"May2025\" height=\"274\" src=\"https://image.prepladder.com/notes/2r8NQycTvGROX6xqAMo61746429632.png\" width=\"280\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Central fracture-dislocation of the hip\" data-author=\"Samir Benoudina\" data-hash=\"11737\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/central-fracture-dislocation-of-the-acetabulum-2\" data-tags=\"May2025\" height=\"229\" src=\"https://image.prepladder.com/notes/rT2uaJzChN8SkicIU7aK1746429672.png\" width=\"311\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "As the intern on duty, your responsibility includes attending to patients involved in a road traffic accident. Identify the patient from the options below for whom you would promptly contact the orthopaedic resident on call.", "options": [{"label": "A", "text": "Patient with recurrent shoulder dislocation", "correct": false}, {"label": "B", "text": "Patient with a fractured arm with capillary refill time of less than 3 seconds in his fingers", "correct": false}, {"label": "C", "text": "Patient with a fractured arm with a 10 cm long incision over the arm", "correct": false}, {"label": "D", "text": "Patient with a fractured arm with capillary refill time of 5 seconds in his fingers", "correct": true}], "correct_answer": "D. Patient with a fractured arm with capillary refill time of 5 seconds in his fingers", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a 30-year-old patient who has presented with flaccid bullae on her skin that are prone to easy rupture, with the biopsy showing a suprabasal split?", "options": [{"label": "A", "text": "Pemphigus vulgaris", "correct": true}, {"label": "B", "text": "Pemphigus foliaceus", "correct": false}, {"label": "C", "text": "Pemphigus vegetans", "correct": false}, {"label": "D", "text": "Erythema multiforme", "correct": false}], "correct_answer": "A. Pemphigus vulgaris", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blister Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histopathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Immunofluorescence</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pemphigus vulgaris</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Flaccid bullae, oral lesions</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Suprabasal split, acantholysis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IgG in <span class=\"customMeta\" data-dictid=\"021501f2831692777190ef9ba827fb\">intercellular</span> spaces (fishnet pattern)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pemphigus foliaceus </strong><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Superficial, crusted lesions</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Subcorneal split</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Similar <span class=\"customMeta\" data-dictid=\"2d9b37c62116927771891f3784d2c8\">IgG</span> deposits</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bullous pemphigoid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tense bullae, no mucosal involvement</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Subepidermal split</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Linear <span class=\"customMeta\" data-dictid=\"2d9b37c62116927771891f3784d2c8\">IgG</span> at BMZ</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dermatitis herpetiformis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Grouped vesicles, pruritic</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neutrophilic abscesses in <span class=\"customMeta\" data-dictid=\"532334711316927771865e5309b763\">dermal</span> papillae</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IgA at <span class=\"customMeta\" data-dictid=\"532334711316927771865e5309b763\">dermal</span> papillae</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented with symptoms of delayed adaptation to vision in dark places, gritty sensation in the eyes, dry eyes, and softening of the cornea. What is the likely deficiency in this case?", "options": [{"label": "A", "text": "Retinoic acid", "correct": true}, {"label": "B", "text": "Riboflavin", "correct": false}, {"label": "C", "text": "Niacin", "correct": false}, {"label": "D", "text": "Pantothenic acid", "correct": false}], "correct_answer": "A. Retinoic acid", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>XN</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Night blindness.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>X1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>X1A: Conjunctival xerosis.</li>\n<li>X1B: Bitot spots.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>X2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Corneal xerosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>X3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>X3A: Corneal ulceration, less than one-third.</li>\n<li>X3B: Corneal ulceration, more than one-third.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>XS</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Corneal scar.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>XF</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Xerophthalmic fundus.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the treatment of choice for a patient with paronychia, as shown in the image below?", "options": [{"label": "A", "text": "Amoxiclav", "correct": true}, {"label": "B", "text": "Metronidazole", "correct": false}, {"label": "C", "text": "Amikacin", "correct": false}, {"label": "D", "text": "Norfloxacin", "correct": false}], "correct_answer": "A. Amoxiclav", "question_images": ["https://image.prepladder.com/content/XIAbTpoxXBpA9j5lVhit1745394765.png"], "explanation_images": ["https://image.prepladder.com/notes/n4sAekaTFOttjcErJw6m1746430904.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Acute Paronychia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Chronic Paronychia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bacterial (Staph aureus, Streptococci)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fungal (Candida)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rapid, painful swelling</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gradual, less painful</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pus Formation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Yes, common</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rare</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Drainage + <strong>Amoxiclav</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Antifungals (topical clotrimazole)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which type of alopecia is commonly associated with inflammatory alopecia in a 30-year-old male patient who presents with tinea capitis infection?", "options": [{"label": "A", "text": "Endothrix and Favus", "correct": false}, {"label": "B", "text": "Ectothrix and Endothrix", "correct": false}, {"label": "C", "text": "Favus and Kerion", "correct": true}, {"label": "D", "text": "Kerion and Endothrix", "correct": false}], "correct_answer": "C. Favus and Kerion", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/SnuNYdu1pg4kVsqI01d51746431150.png", "https://image.prepladder.com/notes/tt9iTUsqV6nxP4JPD0BI1746431178.png", "https://image.prepladder.com/notes/xbMMhgRU53wcttWMXi7S1746431208.png", "https://image.prepladder.com/notes/fXLqL2RyXv5xoXVVEKsd1746431227.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causative Organisms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hair Involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ectothrix</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Ectothrix hyphae and spores\" data-author=\"Yang, Zhihui &amp; Chen, Wei &amp; Wan, Zhe &amp; Song, Yinggai &amp; Li, Ruoyu. \" data-hash=\"11754\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/a-b-Ectothrix-hyphae-and-spores-revealed-in-the-direct-KOH-examination-and-fluorescence_fig3_348804477\" data-tags=\"May2025\" height=\"436\" src=\"https://image.prepladder.com/notes/SnuNYdu1pg4kVsqI01d51746431150.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Microsporum species</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Outside hair shaft</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fluoresces under Wood's lamp</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endothrix</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Endothrix Infecrtion\" data-author=\"Sombatmaithai, Alita &amp; Pattanaprichakul, Penvadee &amp; Tuchinda, Papapit &amp; Surawan, Theetat &amp; Muanprasart, Chanai &amp; Matthapan, Lalita &amp; Bunyaratavej, Sumanas.\" data-hash=\"11756\" data-license=\"CC BY 3.0\" data-source=\"https://www.researchgate.net/figure/A-KOH-examination-of-hair-shaft-presented-a-positive-endothrix-result-B-Dermoscopic_fig3_279301846\" data-tags=\"May2025\" height=\"213\" src=\"https://image.prepladder.com/notes/tt9iTUsqV6nxP4JPD0BI1746431178.png\" width=\"328\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Trichophyton tonsurans</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inside hair shaft</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No fluorescence</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Kerion</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Kerion \" data-author=\"Dalal, Ashish &amp; Chawla, Suraj &amp; Vohra, Prakriti &amp; Sangwan, Jyoti &amp; Janshruti,.\" data-hash=\"11758\" data-license=\"CC BY NC 4.0\" data-source=\"https://www.researchgate.net/figure/Kerion-inflammatory-tineacapitis-inflamed-boggy-swelling-studded-with-pustules_fig1_364104573\" data-tags=\"May2025\" height=\"251\" src=\"https://image.prepladder.com/notes/xbMMhgRU53wcttWMXi7S1746431208.png\" width=\"233\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align:center\"> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Trichophyton verrucosum</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inflammatory, patchy alopecia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Boggy swelling, pustules</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Favus</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Favus\" data-author=\"Jae Wan Park, Guk Jin Jeong, Seong Jun Seo, Kapsok Li,\" data-hash=\"11760\" data-license=\"CC BY 4.0\" data-source=\"https://onlinelibrary.wiley.com/doi/10.1111/iwj.12320\" data-tags=\"May2025\" height=\"219\" src=\"https://image.prepladder.com/notes/fXLqL2RyXv5xoXVVEKsd1746431227.png\" width=\"239\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Trichophyton schoenleinii</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Permanent <span class=\"customMeta\" data-dictid=\"e9dcc3d4241692777198c7030bf313\">scarring</span> alopecia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Honeycomb scutula</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented with joint pain and on evaluation, urine turns black on standing. What is the likely enzyme deficiency?", "options": [{"label": "A", "text": "Homogentisic acid 1,2-dioxygenase", "correct": true}, {"label": "B", "text": "Tyrosine transaminase", "correct": false}, {"label": "C", "text": "Fumarylacetoacetase hydrolase", "correct": false}, {"label": "D", "text": "4-hydroxy-phenyl pyruvate dioxygenase", "correct": false}], "correct_answer": "A. Homogentisic acid 1,2-dioxygenase", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/XHzLH1Vp2kMlTWsrN0W31746430410.png", "https://image.prepladder.com/notes/Xi8qVjg1eAn9tJAZiSTT1746430481.png", "https://image.prepladder.com/notes/y2pVpUIp06MRlbm3zyAI1746430451.png"], "explanation": "<p>Correct Option A: Homogentisic acid 1,2-dioxygenase</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1. Homogentisic Aciduria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Presence of <span class=\"customMeta\" data-dictid=\"d442747c48169277718942db69fa7e\">homogentisic acid</span> in the urine, which turns dark upon standing or when exposed to air.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2. Ochronosis</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Ochronosis - Osler's Sign\" data-author=\"Andreas Wilke Dietmar Steverding\" data-hash=\"11741\" data-license=\"CC BY 2.0\" data-source=\"https://www.researchgate.net/figure/Ochronotic-pigment-on-the-sclera-of-the-eyes-of-the-patient_fig1_40900488\" data-tags=\"May2025\" height=\"108\" src=\"https://image.prepladder.com/notes/XHzLH1Vp2kMlTWsrN0W31746430410.png\" width=\"219\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Deposition of dark <span class=\"customMeta\" data-dictid=\"05e2e2617c16927771952bcbeea08b\">pigment</span> in <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissues, particularly noticeable in the ear cartilage, sclera, and other <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissues, leading to a bluish-black discoloration.The image shows Osler’s sign.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3. Arthropathy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Degenerative joint disease, especially affecting the spine and large joints, leading to chronic pain and stiffness.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>4. <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">Cardiac</span> Involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Includes <span class=\"customMeta\" data-dictid=\"efba33a3fd1692777189906f884236\">heart valve</span> <span class=\"customMeta\" data-dictid=\"a1ee14c673169277718351bfe6afd4\">calcification</span> and <span class=\"customMeta\" data-dictid=\"2991baa5dd16927771828a23544924\">atherosclerosis</span> due to the deposition of <span class=\"customMeta\" data-dictid=\"05e2e2617c16927771952bcbeea08b\">pigment</span> in <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> tissues.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Reaction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Enzyme</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Associated Disorder</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tyrosine → p-Hydroxyphenylpyruvate</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tyrosine transaminase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tyrosinemia type II</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>p-Hydroxyphenylpyruvate → Homogentisate</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>p-Hydroxyphenylpyruvate dioxygenase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tyrosinemia type III</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Homogentisate → Maleylacetoacetate</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Homogentisate 1,2-dioxygenase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Alkaptonuria</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Maleylacetoacetate → Fumarylacetoacetate</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Maleylacetoacetate isomerase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fumarylacetoacetate → Fumarate + Acetoacetate</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fumarylacetoacetate hydrolase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tyrosinemia type I</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What would be your next best course of action when a patient undergoing multi-drug therapy (MDT) exhibits deterioration of preexisting lesions and nerve involvement?", "options": [{"label": "A", "text": "Stop MDT, start systemic corticosteroids", "correct": false}, {"label": "B", "text": "Continue MDT, start systemic steroids", "correct": true}, {"label": "C", "text": "Stop MDT thalidomide Continue MDT, start thalidomide", "correct": false}, {"label": "D", "text": "Continue MDT, start thalidomide", "correct": false}], "correct_answer": "B. Continue MDT, start systemic steroids", "question_images": ["https://image.prepladder.com/content/UXJCWYECoPL7hvlBCXxl1745395188.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 1 (Reversal Reaction)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased <strong>cell-mediated <span class=\"customMeta\" data-dictid=\"4f9ee631c21692777189b1e0cdc91c\">immunity</span> (CMI)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Worsening of <strong>existing lesions</strong>, erythema, edema, nerve pain</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Continue MDT</strong>, start <strong>systemic steroids</strong> (prednisolone)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Type 2 (Erythema Nodosum Leprosum - ENL)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Immune complex deposition</strong> (TNF-α mediated)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Painful nodules</strong>, fever, neuritis, <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> symptoms</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Continue MDT</strong>, start <strong>thalidomide or steroids</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A farmer presented with loose stools and rashes over the sun-exposed areas. Careful diet history reveals a diet rich in maize. Which of the following deficiencies would you suspect?", "options": [{"label": "A", "text": "Niacin", "correct": true}, {"label": "B", "text": "Pyridoxine", "correct": false}, {"label": "C", "text": "Thiamine", "correct": false}, {"label": "D", "text": "Biotin", "correct": false}], "correct_answer": "A. Niacin", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/moKGIIbP9C1O0GzTA3hz1745395354.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An alcoholic patient presented with itchy lesions as shown in the image. He also has a red-colored beefy tongue. Which of the following histories would you like to ask/elicit in this patient additionally?", "options": [{"label": "A", "text": "Ask for diarrhea and a history of memory loss", "correct": true}, {"label": "B", "text": "Ask for diarrhea, thiamine deficiency features, and detailed dietary history", "correct": false}, {"label": "C", "text": "History of allergy", "correct": false}, {"label": "D", "text": "Ask for diarrhea and conjunctivitis", "correct": false}], "correct_answer": "A. Ask for diarrhea and a history of memory loss", "question_images": ["https://image.prepladder.com/notes/Qa9nxqZKktPRg3zBu8Ew1746432182.png"], "explanation_images": ["https://image.prepladder.com/content/NjT4fho3XgWKbxdnnN2Y1745395802.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "You are conducting an experiment on mitochondrial respiration. You add malate/pyruvate and respiration is normal. You add succinate and respiration is normal. When you add another substance in the presence of pyruvate/succinate and malate, respiration is blocked. Which of the following substances is most likely added?", "options": [{"label": "A", "text": "Rotenone", "correct": false}, {"label": "B", "text": "Antimycin A", "correct": false}, {"label": "C", "text": "Oligomycin", "correct": true}, {"label": "D", "text": "2,4-dinitrophenol", "correct": false}], "correct_answer": "C. Oligomycin", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Inhibitor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Target Site</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mechanism</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rotenone </strong><strong>(Option A)</strong></p>\n<p><strong>Amobarbital</strong></p>\n<p><strong>Piericidin A</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Complex I</p>\n<p>(NADH dehydrogenase)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blocks <span class=\"customMeta\" data-dictid=\"d416281a201692777187899c00aed8\">electron</span> transfer from Complex I to ubiquinone</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>TTFA (Thenoyltrifluoroacetone)</strong></p>\n<p><strong>Carboxin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Complex II</p>\n<p>(Succinate dehydrogenase)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blocks <span class=\"customMeta\" data-dictid=\"d416281a201692777187899c00aed8\">electron</span> transfer from Complex II to ubiquinone</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Malonate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Complex II</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Malonate is a competitive <span class=\"customMeta\" data-dictid=\"b5fb56a28b1692777190396ae8b625\">inhibitor</span> of Complex II.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antimycin A</strong><strong> (Option B)</strong></p>\n<p><strong>BAL</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Complex III</p>\n<p>Cytochrome bc1 complex</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blocks <span class=\"customMeta\" data-dictid=\"d416281a201692777187899c00aed8\">electron</span> transfer from Complex III to <span class=\"customMeta\" data-dictid=\"29e8e2a5dd16927771855db589c581\">Cytochrome</span> C.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cyanide (CN−) </strong></p>\n<p><strong>Carbon <span class=\"customMeta\" data-dictid=\"03077f6c8716927771923763487a9e\">monoxide</span> (CO) </strong></p>\n<p><strong>Hydrogen <span class=\"customMeta\" data-dictid=\"0e84bc8bb5169277719934af06eb80\">Sulfide</span> (H2S) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Complex IV</p>\n<p>(Cytochrome c Oxidase)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Prevents <span class=\"customMeta\" data-dictid=\"d416281a201692777187899c00aed8\">electron</span> transfer from Complex IV to oxygen</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Oligomycin</strong><strong> (Option A) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>ATP <span class=\"customMeta\" data-dictid=\"d2bd91ccac169277719941254e1795\">Synthase</span> (Complex V)</p>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blocks the <span class=\"customMeta\" data-dictid=\"9c823198d61692777196bc71097d6d\">proton</span> channel of <span class=\"customMeta\" data-dictid=\"5abb3a7e7f1692777182a8f4c42522\">ATP</span> synthase, preventing <span class=\"customMeta\" data-dictid=\"5abb3a7e7f1692777182a8f4c42522\">ATP</span> synthesis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Atractyloside</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Adenine <span class=\"customMeta\" data-dictid=\"94a2f0970016927771932885a3d362\">Nucleotide</span> Translocase</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blocks ADP/ATP exchange across the mitochondrial membrane</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following glycosaminoglycans (GAGs) are responsible for corneal transparency?", "options": [{"label": "A", "text": "Keratan sulfate", "correct": true}, {"label": "B", "text": "Chondroitin sulfate", "correct": false}, {"label": "C", "text": "Heparin sulfate", "correct": false}, {"label": "D", "text": "Hyaluronic acid", "correct": false}], "correct_answer": "A. Keratan sulfate", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mucopolysaccharide</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Primary Locations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Functions</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hyaluronic Acid </strong><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Connective tissues, tendons, <span class=\"customMeta\" data-dictid=\"d27f9c7a1b16927771999b1679d949\">synovial</span> fluid, <span class=\"customMeta\" data-dictid=\"636ccb4336169277720289af6a0778\">vitreous</span> humor</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Serves as a <span class=\"customMeta\" data-dictid=\"ddc9f397e716927771916135359875\">lubricant</span> in joint cavities and contributes to the structure of <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissues</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Heparin </strong><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Liver, lungs, spleen, monocytes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acts as an <span class=\"customMeta\" data-dictid=\"b5fc7729f316927771817f809648f5\">anticoagulant</span> by activating <span class=\"customMeta\" data-dictid=\"fa202015a216927771814a0dc268ba\">antithrombin</span> III, which inactivates <span class=\"customMeta\" data-dictid=\"ac7e1f394f1692777200c5bb11e4d8\">thrombin</span> and other <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> factors</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chondroitin <span class=\"customMeta\" data-dictid=\"535af9a2181692777199309af44d24\">Sulfate</span> </strong><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cartilage, bone, tendons, cornea, skin</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Provides structural support to <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissues and contributes to their <span class=\"customMeta\" data-dictid=\"b11364e7ed169277719777251a2bfe\">resilience</span> and elasticity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Keratan <span class=\"customMeta\" data-dictid=\"535af9a2181692777199309af44d24\">Sulfate</span> </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cornea, cartilage</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dermatan <span class=\"customMeta\" data-dictid=\"535af9a2181692777199309af44d24\">Sulfate</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Skin, blood vessels, heart valves</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Contributes to the structure of the skin, blood vessels, and heart valves</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In this scenario, what is the origin of the blood glucose measured at 7 am the following morning for an individual who had dinner at 8 pm the previous night?", "options": [{"label": "A", "text": "Hepatic glycogenolysis", "correct": true}, {"label": "B", "text": "Hepatic gluconeogenesis", "correct": false}, {"label": "C", "text": "Muscle glycogenolysis", "correct": false}, {"label": "D", "text": "Dietary glucose", "correct": false}], "correct_answer": "A. Hepatic glycogenolysis", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/VdBCOWyMJNIcxK6jNUgg1746432489.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient who has been diagnosed with multiple gastrointestinal polyps and carcinoma, with a positive family history/history of hereditary non-polyposis colon carcinoma has a defect in which of the following?", "options": [{"label": "A", "text": "Mismatch repair", "correct": true}, {"label": "B", "text": "Nucleotide excision repair", "correct": false}, {"label": "C", "text": "Base excision repair", "correct": false}, {"label": "D", "text": "Point mutation", "correct": false}], "correct_answer": "A. Mismatch repair", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Associated DNA Repair Pathway</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Xeroderma Pigmentosum</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nucleotide <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">Excision</span> Repair (NER)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cockayne Syndrome</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nucleotide <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">Excision</span> Repair (NER)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lynch Syndrome</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mismatch Repair (MMR)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>MUTYH-Associated Polyposis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Base <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">Excision</span> Repair (BER)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ataxia-Telangiectasia (A-T)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Double-Strand Break Repair (DSBR)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fanconi Anemia</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>DNA Crosslink Repair</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Breast and Ovarian Cancer</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Homologous <span class=\"customMeta\" data-dictid=\"3a379aaafc1692777197e1f873883d\">Recombination</span> Repair</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Werner Syndrome</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>DNA <span class=\"customMeta\" data-dictid=\"b743df46a21692777188fd0624955a\">Helicase</span> Repair</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bloom Syndrome</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>DNA <span class=\"customMeta\" data-dictid=\"b743df46a21692777188fd0624955a\">Helicase</span> Repair</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Trichothiodystrophy (TTD)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nucleotide <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">Excision</span> Repair (NER)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Colorectal Cancer</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mismatch Repair (MMR)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young girl presented to the OPD for an examination. She is tall and thin with slender fingers, and dislocated lenses. Workup revealed cystathione beta-synthase deficiency. Which amino acid supplement is required in this case?", "options": [{"label": "A", "text": "Cysteine", "correct": true}, {"label": "B", "text": "Methionine", "correct": false}, {"label": "C", "text": "Serine", "correct": false}, {"label": "D", "text": "Tyrosine", "correct": false}], "correct_answer": "A. Cysteine", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type - I Homocystinuria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type - II Homocystinuria</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Enzyme Deficiency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cystathionine beta-synthase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Methionine synthase</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Metabolic <span class=\"customMeta\" data-dictid=\"3aa5abc2fa169277719488e088076d\">Pathway</span> Affected</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Homocysteine to cystathionine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Homocysteine to methionine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Elevated Metabolites</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Homocysteine and methionine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Homocysteine and elevated levels of Cysteine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Biochemical Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Low levels of cysteine.</li>\n<li>High levels of methionine.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>High levels of cysteine.</li>\n<li>Low levels of methionine.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Vitamin B6 (pyridoxine) supplementation; low-methionine diet; <span class=\"customMeta\" data-dictid=\"dabfa103741692777185dac756c49b\">cysteine</span> supplementation</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vitamin B12 and <span class=\"customMeta\" data-dictid=\"c66705291e1692777203ed3498a606\">folate</span> supplementation; low-methionine diet</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the diagram provided, which enzymes are identified as E1 and E2, responsible for the conversion of pyruvate to acetyl CoA?", "options": [{"label": "A", "text": "Pyruvate dehydrogenase and dihydrolipoyl transacetylase", "correct": true}, {"label": "B", "text": "Pyruvate carboxylase and dihydrolipoyl transacetylase", "correct": false}, {"label": "C", "text": "Pyruvate dehydrogenase and dihydrolipoyl dehydrogenase", "correct": false}, {"label": "D", "text": "Pyruvate carboxylase and dihydrolipoyl dehydrogenase", "correct": false}], "correct_answer": "A. Pyruvate dehydrogenase and dihydrolipoyl transacetylase", "question_images": ["https://image.prepladder.com/notes/dD4IvAmNuhTR0qT7e6O31746432854.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 27 year old female patient was found to have uterus didelphys. Which of the following is not likely to be a complication to this uterine anomaly?", "options": [{"label": "A", "text": "Abortion", "correct": false}, {"label": "B", "text": "Endometriosis", "correct": false}, {"label": "C", "text": "Preterm labor", "correct": false}, {"label": "D", "text": "Transverse lie", "correct": true}], "correct_answer": "D. Transverse lie", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/lJQhScaclMR4XRFm2soh1746433337.png", "https://image.prepladder.com/notes/5L6If3ij8kSOKVbLhiRg1746433514.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 5 year old boy presented with easy fatigability, irritability and inability to concentrate. Labs revealed the following findings a and b (light and oil immersion respectively) on the bone marrow aspiration. Which of the following is the most likely enzyme deficient in this condition?", "options": [{"label": "A", "text": "Hexosaminidase", "correct": false}, {"label": "B", "text": "Glucocerebrosidase", "correct": true}, {"label": "C", "text": "Sphingomyelinase", "correct": false}, {"label": "D", "text": "N-acetyglucosaminidase", "correct": false}], "correct_answer": "B. Glucocerebrosidase", "question_images": ["https://image.prepladder.com/notes/6FOYngUDXY3zkGI6XbMj1746433760.png"], "explanation_images": ["https://image.prepladder.com/notes/zSD2nvZ1P8sq8DkxxBPL1746433911.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Enzyme deficiency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Substance accumulation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tay-Sachs disease</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hexosaminidase A <strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ganglioside</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mental retardation</li>\n<li>Blindness</li>\n<li>Muscular weakness</li>\n<li>Cherry red spots in the macula</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Niemann-Pick disease </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sphingomyelinase <strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sphingomyelin</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Enlarged liver and spleen</li>\n<li>Mental retardation</li>\n<li>Fatal in early life</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sanfilippo Syndrome</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>N-acetyglucosaminidase <strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the appropriate management for a 35-year-old woman with choriocarcinoma who presents with metastases to lung spleen and kidney, had a previous molar pregnancy removed 6 months ago, a pretreatment serum hCG level of 10,000IU/ml, a tumor of 6 cm diameter in the uterus, and failed chemotherapy with methotrexate?", "options": [{"label": "A", "text": "Methotrexate with folinic acid", "correct": false}, {"label": "B", "text": "Methotrexate", "correct": false}, {"label": "C", "text": "EMACO regimen", "correct": true}, {"label": "D", "text": "Hysterectomy", "correct": false}], "correct_answer": "C. EMACO regimen", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:629px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Scores</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>4</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Age (years)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;40</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≥40</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Antecedent pregnancy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mole</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abortion</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Term</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Interval months from index pregnancy</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4-6</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>7-12</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;12</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pretreatment <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> β-hCG (mIU/mL)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;10³</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10³-&lt;10⁴</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10⁴-&lt;10⁵</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≥10⁵</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Largest tumor size (including uterus)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;3 cm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3-4 cm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≥5 cm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Site of metastases</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Spleen, kidney</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>GIT</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Liver, brain</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Number of metastases</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1-4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5-8</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;8</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Previous failed <span class=\"customMeta\" data-dictid=\"8602c4b260169277718439bb122cb0\">chemotherapy</span> drugs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≥2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A pregnant woman at 36 weeks of gestation with a prosthetic valve replacement for mitral stenosis is on warfarin therapy. Her INR is 3. What is the appropriate next step in management? LMWH- Low molecular weight heparin", "options": [{"label": "A", "text": "Stop warfarin and start LMWH", "correct": true}, {"label": "B", "text": "Stop warfarin and start heparin", "correct": false}, {"label": "C", "text": "Continue warfarin", "correct": false}, {"label": "D", "text": "Stop warfarin, start LMWH and aspirin", "correct": false}], "correct_answer": "A. Stop warfarin and start LMWH", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/liWFSfetB45wN0vPh72f1746434232.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What could be the possible diagnosis for a patient who exhibited tendon xanthomas, with his lipid profile indicating serum cholesterol levels of 283 mg/dL and serum LDL levels of 202 mg/dL, and subsequently initiated on lovastatin treatment?", "options": [{"label": "A", "text": "Familial hypercholesterolemia", "correct": true}, {"label": "B", "text": "Tangier's disease", "correct": false}, {"label": "C", "text": "Lipoprotein lipase deficiency", "correct": false}, {"label": "D", "text": "Familial hyperchylomicronemia", "correct": false}], "correct_answer": "A. Familial hypercholesterolemia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type IIa (Familial Hypercholesterolemia)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Defect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Defective <span class=\"customMeta\" data-dictid=\"4e4438ab5c16927771919ca536a59f\">LDL</span> receptors or Apo B-100 <span class=\"customMeta\" data-dictid=\"6e1f8c026516927771919d54418520\">ligand</span> region mutation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lipoprotein Fraction Elevated</strong><strong> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>LDL</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Main <span class=\"customMeta\" data-dictid=\"a99114a6c216927771916f45ffc66c\">Lipid</span> Abnormality</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypercholesterolemia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Laboratory findings</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Raised <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"4e4438ab5c16927771919ca536a59f\">LDL</span> and Cholesterol</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Features</strong>.</p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Atherosclerosis</li>\n<li>Coronary <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> disease (early onset)</li>\n<li><strong>Tendon xanthomas</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Statins</strong></li>\n<li>PUFA</li>\n<li>Lifestyle modifications (diet, exercise)</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which drug is most likely responsible for the occurrence of hyperthermia and muscle rigidity in a patient undergoing surgery while being administered anesthesia with halothane?", "options": [{"label": "A", "text": "D-curare", "correct": false}, {"label": "B", "text": "Suxamethonium", "correct": true}, {"label": "C", "text": "Cis-atracurium", "correct": false}, {"label": "D", "text": "Rocuronium", "correct": false}], "correct_answer": "B. Suxamethonium", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old female patient has a history of three miscarriages. Identify the investigation that was done using the image shown below.", "options": [{"label": "A", "text": "Hysteroscopy", "correct": false}, {"label": "B", "text": "Saline infusion sonography", "correct": false}, {"label": "C", "text": "Hysterosalpingography", "correct": true}, {"label": "D", "text": "Transvaginal ultrasonography", "correct": false}], "correct_answer": "C. Hysterosalpingography", "question_images": ["https://image.prepladder.com/content/xBUmuk5M4eFBFjYC5ieD1745400732.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:576px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Preparation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>NSAID 30 minutes before to prevent <span class=\"customMeta\" data-dictid=\"a970a38e85169277720171bea632e7\">tubal</span> spasm.</li>\n<li><strong>Paracervical block</strong> in patients with <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> stenosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>4 phases of radiographic images taken</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pre-contrast preliminary.</li>\n<li>During contrast filling.</li>\n<li>Contrast spillage into peritoneum.</li>\n<li>During deflation and withdrawal.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Contraindications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Acute <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> infections.</li>\n<li>Active <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> bleeding.</li>\n<li>Allergic to iodine.</li>\n<li>Pregnancy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Doxycycline can be given</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>If dilated tubes are identified (indicating previous <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> infection).</li>\n<li>As <span class=\"customMeta\" data-dictid=\"bc36e9b9381692777196b5f9a2f79c\">prophylaxis</span> to prevent infections post-HSG.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pelvic discomfort.</li>\n<li>Uterine perforation.</li>\n<li>Vasovagal reactions.</li>\n<li>Dye allergy.</li>\n<li>Intravascular dissemination of the dye.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented with headache, vomiting, and fever. Meningitis was suspected. While performing a lumbar puncture, which is the last structure you will pierce just before entering the lumbar cistern?", "options": [{"label": "A", "text": "Ligamentum flavum", "correct": false}, {"label": "B", "text": "Dura mater", "correct": false}, {"label": "C", "text": "Arachnoid membrane", "correct": true}, {"label": "D", "text": "Pia mater", "correct": false}], "correct_answer": "C. Arachnoid membrane", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 56-year-old multipara woman presented with grade ll/I uterine prolapse with cystocele. She complains of passing urine on coughing and sneezing. What type of urinary incontinence is seen in this patient?", "options": [{"label": "A", "text": "Overflow incontinence", "correct": false}, {"label": "B", "text": "Urge incontinence", "correct": false}, {"label": "C", "text": "Stress incontinence", "correct": true}, {"label": "D", "text": "Neurogenic bladder", "correct": false}], "correct_answer": "C. Stress incontinence", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young male patient was given a regional block with 0.25% bupivacaine for a minor surgical procedure. Shortly after the injection, the patient suddenly became unresponsive, and the pulse was not recordable. Which of the following would be the best course of management for this patient?", "options": [{"label": "A", "text": "CPR with 20% intralipid", "correct": true}, {"label": "B", "text": "CPR with sodium bicarbonate", "correct": false}, {"label": "C", "text": "CPR with dobutamine", "correct": false}, {"label": "D", "text": "CPR with calcium", "correct": false}], "correct_answer": "A. CPR with 20% intralipid", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32-year-old married woman who came for the evaluation of infertility was found to have a septum in her uterine cavity. What would be the appropriate management of this case?", "options": [{"label": "A", "text": "Hysterectomy", "correct": false}, {"label": "B", "text": "Laparoscopy and metroplasty", "correct": false}, {"label": "C", "text": "Hysteroscopy and septoplasty", "correct": true}, {"label": "D", "text": "Laparotomy and metroplasty", "correct": false}], "correct_answer": "C. Hysteroscopy and septoplasty", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the specific action being demonstrated in the provided image?", "options": [{"label": "A", "text": "Head tilt, chin lift", "correct": true}, {"label": "B", "text": "Jaw thrust", "correct": false}, {"label": "C", "text": "Head extension", "correct": false}, {"label": "D", "text": "In line manual stabilisation", "correct": false}], "correct_answer": "A. Head tilt, chin lift", "question_images": ["https://image.prepladder.com/content/95atdGKSPByHJY9cx4zn1745401315.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely vector for the disease in a patient from Uttar Pradesh who presented with symptoms of fever, pallor, hepatosplenomegaly, pancytopenia, peripheral smear examination showing macrophages laden with organisms containing a kinetoplast?", "options": [{"label": "A", "text": "Sandfly", "correct": true}, {"label": "B", "text": "Tse-Tse fly", "correct": false}, {"label": "C", "text": "Triatomine bug", "correct": false}, {"label": "D", "text": "Female anopheles mosquito", "correct": false}], "correct_answer": "A. Sandfly", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/CuoQvezhkfZxDD8PbsNm1746435007.png", "https://image.prepladder.com/notes/l6SQk4ZAgsio3M0jzTng1746435027.png", "https://image.prepladder.com/notes/SiPlOoDopHidSkv2FyTN1746435061.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Characteristic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Trypanosoma brucei</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Trypanosoma cruzi</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align: center;\"><strong>Leishmania</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Flagellate protozoan</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Flagellate protozoan</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Flagellate protozoan</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Subtypes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>T.b. gambiense, T.b. rhodesiense</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>L. donovani, L. tropica, L. braziliensis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Disease Caused</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>African sleeping <span class=\"customMeta\" data-dictid=\"73c1caf8d11692777198b1248373d3\">sickness</span> (Trypanosomiasis)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Chagas disease</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>L. donovani: Visceral <span class=\"customMeta\" data-dictid=\"f60a0a7ad716927771916ed83e3586\">leishmaniasis</span> (Kala-azar)</p>\n<p>L. tropica: Cutaneous</p>\n<p>L. braziliensis: Mucocutaneous</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Vector</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Tsetse fly (Glossina)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Triatomine bug (“Kissing bug”)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Sandfly (Phlebotomus)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Infective Form</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Trypomastigote</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Trypomastigote</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Promastigote</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Chronicity / Progression</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Gambiense: Slow progression</p>\n<p>Rhodesiense: Rapid progression</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Acute (mild) to Chronic (severe, e.g., cardiomyopathy, megaesophagus)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Progresses to chronic (Visceral: fatal if untreated)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Suramin (early), Melarsoprol (late), Pentamidine and Eflornithine (alternative)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Nifurtimox, Benznidazole</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Amphotericin B, Miltefosine, Sodium Stibogluconate</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which vaccine is administered as part of the immunization program for a 10- year-old student in school?", "options": [{"label": "A", "text": "BCG", "correct": false}, {"label": "B", "text": "MMR", "correct": false}, {"label": "C", "text": "TT/ Td", "correct": true}, {"label": "D", "text": "DPT", "correct": false}], "correct_answer": "C. TT/ Td", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Vaccine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Route</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Site</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type of Vaccine</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>BCG (Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>At birth (up to 1 year)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intradermal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Left upper arm</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Live attenuated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hepatitis B (Birth Dose)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>At birth (within 24 hrs)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intramuscular</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anterolateral thigh</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inactivated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>OPV (Zero Dose)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>At birth (within 15 days)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Oral</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Live attenuated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pentavalent (DPT + Hib + <span class=\"customMeta\" data-dictid=\"d3d938151416927771887e91804b5b\">Hep</span> B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6, 10, 14 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intramuscular</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anterolateral thigh</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>DPT (toxoid), Hib &amp; <span class=\"customMeta\" data-dictid=\"d3d938151416927771887e91804b5b\">Hep</span> B (inactivated)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>OPV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6, 10, 14 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Oral</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Live attenuated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Rotavirus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6, 10, 14 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Oral</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Live attenuated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>IPV (Fractional)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6 &amp; 14 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intradermal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Right upper arm</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inactivated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>PCV (Pneumococcal <span class=\"customMeta\" data-dictid=\"2421c657771692777185af1b7b59c3\">Conjugate</span> Vaccine)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6, 14 weeks, and 9 months</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intramuscular</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anterolateral thigh</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Conjugate</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Measles &amp; <span class=\"customMeta\" data-dictid=\"b8aa1ffb8916927771976438d71d1b\">Rubella</span> (MR) (Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>9-12 months &amp; 16-24 months</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Subcutaneous</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Right upper arm</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Live attenuated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>JE (Japanese Encephalitis)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>9-12 months &amp; 16-24 months</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Subcutaneous</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Left upper arm</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Live attenuated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>DPT Booster-1 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>16-24 months</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intramuscular</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anterolateral thigh</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Toxoid</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>OPV Booster</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>16-24 months</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Oral</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Live attenuated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>PCV Booster</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>9-12 months</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intramuscular</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anterolateral thigh</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Conjugate</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Measles/MR Booster</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>16-24 months</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Subcutaneous</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Right upper arm</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Live attenuated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>DPT Booster-2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>5-6 years</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intramuscular</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Deltoid</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Toxoid</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>TT (Tetanus Toxoid)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>10 years &amp; 16 years</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intramuscular</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Deltoid</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Toxoid</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cervical Cancer (HPV)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>9-14 years (girls)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intramuscular</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Deltoid</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Recombinant</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An unimmunized 2-year-old child presented with cough, coryza, conjunctivitis, and bluish-white spots in his buccal mucosa near the lower molar teeth. A day later, he developed a maculopapular rash on the face and neck. What is the nature of the causative virus?", "options": [{"label": "A", "text": "Enveloped ssRNA", "correct": true}, {"label": "B", "text": "Naked ssRNA", "correct": false}, {"label": "C", "text": "Naked dsRNA", "correct": false}, {"label": "D", "text": "Enveloped ds RNA", "correct": false}], "correct_answer": "A. Enveloped ssRNA", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Duration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Incubation Period</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>10 days (up to 21 days)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Asymptomatic phase; the virus multiplies in the <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> tract, followed by primary and secondary viremia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prodromal Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4 days</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fever (day 10),</li>\n<li>Koplik’s spots (day 12),</li>\n<li>non-specific symptoms (cough, coryza, conjunctivitis).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Eruptive Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4 days post fever</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"a4fdae630a16927771918eaa32d28b\">maculopapular</span> <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> appears first behind the ears, then spreads to the face, trunk, and limbs, <span class=\"customMeta\" data-dictid=\"28b8100e7b1692777202be12974004\">fading</span> in the same order.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Post-measles Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Variable</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Characterized by weight loss, weakness, and a risk of progressing to chronic conditions.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient admitted following a road traffic accident has left a blood spill on the hospital floor. Which disinfectant is most appropriate for effectively decontaminating the area?", "options": [{"label": "A", "text": "Ethyl alcohol", "correct": false}, {"label": "B", "text": "Chlorhexidine", "correct": false}, {"label": "C", "text": "Sodium hypochlorite", "correct": true}, {"label": "D", "text": "Formaldehyde", "correct": false}], "correct_answer": "C. Sodium hypochlorite", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Step</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Action</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>1. PPE</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Wear Personal Protective Equipment (PPE)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gloves, goggles/face shield, gown/apron, mask (if necessary) to protect from exposure.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>2. Control the Spill Area</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Secure and contain the spill</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Alert others, prevent access, and use <span class=\"customMeta\" data-dictid=\"0dd21d51461692777180c0b4a3eca8\">absorbent</span> materials (e.g., paper towels) to contain the spill.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>3. Select and Apply Disinfectant</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Use appropriate disinfectant</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sodium <span class=\"customMeta\" data-dictid=\"183f5ac20a16927771890da7bafd33\">hypochlorite</span> (1%)</strong> is preferred. Apply <span class=\"customMeta\" data-dictid=\"7d0c70b0de1692777186c7cebb9a81\">disinfectant</span> to the spill and allow it to sit for 10 minutes.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>4. Clean the Spill</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Wipe the area with <span class=\"customMeta\" data-dictid=\"0dd21d51461692777180c0b4a3eca8\">absorbent</span> materials</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Use disposable towels or wipes to clean up the blood and dispose of them in <span class=\"customMeta\" data-dictid=\"73042b3eae1692777183ca9718a84d\">biohazard</span> waste.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>5. <span class=\"customMeta\" data-dictid=\"e6cfd00622169277718663c52b160c\">Disinfect</span> Surrounding Area</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clean the surrounding floor or surfaces</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mop or wipe down the surrounding area with <span class=\"customMeta\" data-dictid=\"7d0c70b0de1692777186c7cebb9a81\">disinfectant</span> to ensure thorough decontamination.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>6. Dispose of Contaminated Items</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Safely dispose of contaminated materials</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Place used gloves, mop heads, towels, and any contaminated materials in a <strong>biohazard waste</strong> container.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>7. Remove and Dispose of PPE</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Safely remove PPE and dispose of it</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Remove gloves last, ensuring that they are turned inside out. Dispose of PPE in <span class=\"customMeta\" data-dictid=\"73042b3eae1692777183ca9718a84d\">biohazard</span> waste containers.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>8. Wash Hands</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clean hands thoroughly after cleaning</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Wash hands with soap and water, or use alcohol-based hand sanitizer if soap is unavailable.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>9. Documentation and Reporting</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Record the incident and inform relevant departments</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Document the blood spill and cleaning procedure, and report any potential exposures to infection control.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following factors can contribute to the development of malnutrition?", "options": [{"label": "A", "text": "Child rearing", "correct": false}, {"label": "B", "text": "Infectious diseases", "correct": true}, {"label": "C", "text": "Food habits", "correct": false}, {"label": "D", "text": "Socioeconomic factors", "correct": false}], "correct_answer": "B. Infectious diseases", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Infection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Effect on Nutrition</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diarrheal diseases</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Causes <strong>fluid and nutrient loss</strong>, leading to <span class=\"customMeta\" data-dictid=\"da07fd59a11692777185e23c69af5e\">dehydration</span> and malabsorption.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tuberculosis (TB)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increases <strong>catabolism (muscle breakdown)</strong>, leading to weight loss.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Parasitic infections (e.g., hookworm, giardiasis)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Causes <strong>iron <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> anemia, protein loss, and malabsorption</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Measles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Leads to <strong>vitamin A deficiency</strong>, impairing immune function.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most relevant information that should be obtained from the medical history of a patient from Chhattisgarh who is experiencing gradual muscle weakness and spasms in the legs, and exhibits only motor impairment upon examination?", "options": [{"label": "A", "text": "History of similar illness in the past", "correct": false}, {"label": "B", "text": "History of fever", "correct": false}, {"label": "C", "text": "History of vaccination", "correct": false}, {"label": "D", "text": "History of diet", "correct": true}], "correct_answer": "D. History of diet", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:545px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Excessive consumption of <span class=\"customMeta\" data-dictid=\"fc173a5ccf16927771919025005bf3\">Lathyrus</span> sativus (Khesari dal)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Region</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Endemic in Chhattisgarh, Madhya Pradesh, Bihar, Odisha</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gradual-onset <strong>spastic paraparesis</strong>, hyperreflexia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sensory Involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Absent (pure motor disorder)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prevention</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dietary restriction, government bans on Khesari dal</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable causative agent involved in the case of two individuals from a group of 20 friends who experienced nausea and vomiting in the early morning after consuming pastries from an external source during a late-night party?", "options": [{"label": "A", "text": "Enterotoxin of staphylococcus", "correct": true}, {"label": "B", "text": "Emetic toxin of B. cereus", "correct": false}, {"label": "C", "text": "Verocytotoxin from E. coli", "correct": false}, {"label": "D", "text": "Shiga toxin from shigella", "correct": false}], "correct_answer": "A. Enterotoxin of staphylococcus", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Disease caused by <span class=\"customMeta\" data-dictid=\"71c203268816927771994a1fffd645\">Staphylococcus</span> aureus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Key features</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary infection</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Furuncle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Superficial skin infection develops in hair follicles, <span class=\"customMeta\" data-dictid=\"359edf0778169277719886070af9db\">sebaceous</span> gland, or sweat gland.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Carbuncle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Development of one or more abscesses in adjacent <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> tissues due to the spread of infection from a furuncle.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Impetigo</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"870a1d0bab1692777187e92f005fc1\">exfoliative</span> <span class=\"customMeta\" data-dictid=\"41329dc9381692777200a9b6d57cf4\">toxin</span> produced causes bullous impetigo, characterized by blisters.</p>\n<p>Non-bullous <span class=\"customMeta\" data-dictid=\"7e23404d13169277718994a4692d6d\">impetigo</span> is caused by streptococcus.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acute osteomyelitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bacterial growth usually concentrates in a <span class=\"customMeta\" data-dictid=\"16b76d1d1c1692777200240efcb0e2\">terminal</span> blood <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> of the <span class=\"customMeta\" data-dictid=\"8ccb80bd4d169277719296d80e2193\">metaphysis</span> of a long bone, resulting in bone <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> and persistent suppuration.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Necrotizing pneumonia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Caused by strains producing the <span class=\"customMeta\" data-dictid=\"3bd7706d231692777196673c93b747\">PVL</span> leukocidin.</li>\n<li>Localized, destructive abscesses</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endocarditis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>In drug addicts</li>\n<li>Due to bacteremia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Toxins mediated</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Scalded skin syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Erythema and <span class=\"customMeta\" data-dictid=\"83676f1719169277719003a837e078\">intraepidermal</span> <span class=\"customMeta\" data-dictid=\"af1a0ced9d1692777186a726f04230\">desquamation</span> in neonates caused by <span class=\"customMeta\" data-dictid=\"870a1d0bab1692777187e92f005fc1\">exfoliative</span> toxin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Toxic shock syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>TSST-1 (Toxic Shock Syndrome Toxin)</li>\n<li>Early findings: Fever, vomiting, diarrhea, muscle pain</li>\n<li>Later: Shock, renal, and <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> injury, MODS</li>\n<li>Tampon-associated</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Staphylococcal food poisoning</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Vomiting is prominent without fever.</li>\n<li>Ingestion of enterotoxin-contaminated food causing <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> and <span class=\"customMeta\" data-dictid=\"aaabe672c51692777186a829ebdc0c\">diarrhea</span> within<strong> 1 to 5 hours of <span class=\"customMeta\" data-dictid=\"eba893313f16927771906290ce7e79\">ingestion</span> </strong><strong>(Option A)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Virulence factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Key features</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cell wall-associated polymers</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Peptidoglycan</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Activates complement-induced release of <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> cytokines</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Teichoic acid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Adherence to the host cell surface, and shields them from complement-mediated opsonization</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Capsular polysaccharide</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inhibits opsonization</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cell surface</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Protein A</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Anti-complementary</li>\n<li>Anti-phagocytic</li>\n<li>Co-agglutination</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clumping factor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Responsible for the slide <span class=\"customMeta\" data-dictid=\"f7fb4e31f916927771845b31e25215\">coagulase</span> test</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Toxins</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hemolysin </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Alpha hemolysin-</p>\n<ul>\n<li>Lyse sheep and human red blood cells.</li>\n<li>Toxic to macrophages, lysosomes, muscle tissues, the <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> cortex, and the <span class=\"customMeta\" data-dictid=\"f3739d892c1692777184b2e134615c\">circulatory</span> system</li>\n</ul>\n<p>Beta-hemolysins or sphingomyelinase</p>\n<ul>\n<li>Lyse sheep red blood cells only</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Panton-Valentine (PVL) Leucocidin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Synergohymenotropic toxin</li>\n<li>Attacks neutrophils, platelets</li>\n<li>Produced by Methicillin-Resistant Staph. aureus (MRSA)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Enterotoxin (superantigen)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Food poisoning</strong></li>\n<li>Most cases are caused by type A.</li>\n<li>It acts directly on the <span class=\"customMeta\" data-dictid=\"bd1c98736616927771820954b0a744\">autonomic</span> nervous system causing symptoms. <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">Vomiting</span> is stimulated in the brain stem.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Toxic shock syndrome toxin(TSST) (superantigen)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fatal multisystem disease</li>\n<li>Tampon-related TSS</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Epidermolytic/Exfoliative toxin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Staphylococcal scalded skin syndrome (SSSS): the outer layer of the <span class=\"customMeta\" data-dictid=\"e4c62a77731692777187b9c7ded25d\">epidermis</span> gets separated from the underlying tissues.</li>\n<li>Severe <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of SSSS: Ritter's disease in the <span class=\"customMeta\" data-dictid=\"04df903fe8169277719383126b1b02\">newborn</span> and toxic <span class=\"customMeta\" data-dictid=\"616d85c57416927771875ef23f6751\">epidermal</span> <span class=\"customMeta\" data-dictid=\"254d4c2ea21692777193838ccf204d\">necrolysis</span> in older patients.</li>\n<li>Milder forms: <span class=\"customMeta\" data-dictid=\"73d23b64831692777195fed10389ac\">pemphigus</span> neonatorum and bullous impetigo</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Enzymes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Coagulase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clotting of human or rabbit plasma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lipid hydrolases</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Helps in skin and <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> tissue infections</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hyaluronidase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Breaks down the <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissues</li>\n<li>Staphylokinase, protease</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nuclease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Heat-stable DNase</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 3-year-old child presents with fever, loose stools, and blood in the stool. Which enrichment medium is used to isolate the organism from the stool sample?", "options": [{"label": "A", "text": "Robertson cooked meat broth", "correct": false}, {"label": "B", "text": "Alkaline peptone water", "correct": false}, {"label": "C", "text": "Selenite F broth", "correct": true}, {"label": "D", "text": "Brain heart infusion broth", "correct": false}], "correct_answer": "C. Selenite F broth", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which entity is responsible for overseeing the school health programs?", "options": [{"label": "A", "text": "Primary health center", "correct": true}, {"label": "B", "text": "District hospital", "correct": false}, {"label": "C", "text": "Sub-centre", "correct": false}, {"label": "D", "text": "Sub-divisional hospital", "correct": false}], "correct_answer": "A. Primary health center", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:628px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Level</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Name</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Function</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Population Coverage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Staffing</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sub-Centers (SCs) (Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>First point of contact for the community, providing basic healthcare services like immunization, <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> and child health, and health education.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>5,000 people in plain areas, 3,000 in hilly/tribal areas</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1 Female Health Worker (ANM) and 1 Male Health Worker</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Primary Health Centers (PHCs)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Provides integrated <span class=\"customMeta\" data-dictid=\"0968038e2a1692777185ed087c7fd8\">curative</span> and <span class=\"customMeta\" data-dictid=\"e684325d851692777196af9e64013b\">preventive</span> healthcare services for rural populations. Focuses on <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> and child health, immunization, and family planning.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Serves 30,000 people</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Managed by a Medical Officer with supporting healthcare staff</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Block Primary Health Center (Block PHC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Referral point for PHCs within the block, providing <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> and child health services, basic surgeries, and diagnostics.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Serves a block population (typically 30,000–50,000 people)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Medical Officer, Nurses, Lab Technicians</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Community Health Centers (CHCs) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Serves as a referral point for PHCs and provides specialized care.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Serves 80,000 to 1,20,000 people</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Staffed with specialists (e.g., surgeons, obstetricians, pediatricians)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>5</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sub-Divisional Hospitals (SDHs) (Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Provides more advanced care than PHCs or CHCs at the sub-divisional level, offering a broader range of medical services and treatments.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sub-divisional coverage</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Specialists, General Medical Practitioners</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>District Hospitals (Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Provide <span class=\"customMeta\" data-dictid=\"7fad24b851169277719849050e94e1\">secondary care</span> services and act as referral points for CHCs. Services include emergency care, surgeries, and specialized treatments.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>District-level coverage</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Specialists, General Medical Practitioners</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>7</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tertiary Care Hospitals</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Provide advanced medical care and specialized services, such as complex surgeries and treatment for rare conditions.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Multi-district coverage</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Highly trained specialists in various medical fields</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A pregnant woman whose niece lives with her in the same house contracted Varicella. She tested negative for serum antibodies against varicella. What would this mean?", "options": [{"label": "A", "text": "She is immune to zoster", "correct": false}, {"label": "B", "text": "She is susceptible to zoster", "correct": false}, {"label": "C", "text": "She is susceptible to chickenpox", "correct": true}, {"label": "D", "text": "She is immune to chickenpox", "correct": false}], "correct_answer": "C. She is susceptible to chickenpox", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:537px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Serology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Interpretation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Risk Status</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Positive VZV IgG</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Past infection or vaccination</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Immune to chickenpox</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Negative VZV IgG</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No prior exposure</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Susceptible to chickenpox</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Positive VZV IgM</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Recent infection</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Active <span class=\"customMeta\" data-dictid=\"d5b9e7187c16927771847488b5f135\">chickenpox</span> infection</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which type of microscope can be used to detect the motility of the probable causative organism in a truck driver presenting with painless indurated genital ulcer following unprotected sexual activity?", "options": [{"label": "A", "text": "Dark-field microscope", "correct": true}, {"label": "B", "text": "Electron microscope", "correct": false}, {"label": "C", "text": "Light microscope", "correct": false}, {"label": "D", "text": "Fluorescent microscope", "correct": false}], "correct_answer": "A. Dark-field microscope", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/UTyulojD24AmhXCgrp6Y1746435728.png", "https://image.prepladder.com/notes/1iCChc91fT0ZpcZJHyFb1746435763.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Specimen Collection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Lesion cleaned with <span class=\"customMeta\" data-dictid=\"793a8f498b169277718854584fe210\">gauze</span> soaked in warm saline.</li>\n<li>Margins gently scraped to <span class=\"customMeta\" data-dictid=\"a79410cc151692777180e92b6c0ae0\">abrade</span> <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> epithelium.</li>\n<li>Gentle pressure applied to the <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> base to collect <span class=\"customMeta\" data-dictid=\"2df02c8a091692777187db6df500a1\">exudate</span> (prevent blood admixture).</li>\n<li>Serum collected for serology; CSF for neurosyphilis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dark ground microscopy</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Exudate collected and placed under a coverslip.</li>\n<li>Examined with dark ground microscopy.</li>\n<li>T. <span class=\"customMeta\" data-dictid=\"21d1ab68e116927771947438d672b8\">pallidum</span> identified by<strong> slender, tightly coiled <span class=\"customMeta\" data-dictid=\"0b34a9891d16927771998a84595013\">spiral</span> structure showing slow movement.</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Dark Ground Microscopy\" data-author=\"CDC\" data-hash=\"11833\" data-license=\"OPEN ACCESS\" data-source=\"https://commons.wikimedia.org/wiki/File:Treponema_pallidum_cropped.png\" data-tags=\"May2025\" height=\"226\" src=\"https://image.prepladder.com/notes/UTyulojD24AmhXCgrp6Y1746435728.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Silver Impregnation Staining</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fontana’s method is used for <span class=\"customMeta\" data-dictid=\"3b007026bd16927771997ae809b603\">staining</span> <span class=\"customMeta\" data-dictid=\"6777533153169277719804fcbbf2d1\">smear</span> films.</li>\n<li>Levaditi’s method is preferred for tissue sections.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Silver Impregnation Staining\" data-author=\"CDC\" data-hash=\"11835\" data-license=\"OPEN ACCESS\" data-source=\"https://ar.wikipedia.org/wiki/%D9%85%D9%84%D8%AA%D9%88%D9%8A%D8%A7%D8%AA_(%D9%81%D8%B5%D9%8A%D9%84%D8%A9)\" data-tags=\"May2025\" height=\"204\" src=\"https://image.prepladder.com/notes/1iCChc91fT0ZpcZJHyFb1746435763.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old G4A3 woman had a history of miscarriage at 8 weeks, a second miscarriage at 11 weeks with no cardiac activity, and a third pregnancy loss at 24 weeks with preterm delivery due to early-onset preeclampsia. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Syphilis", "correct": false}, {"label": "B", "text": "Antiphospholipid antibody syndrome", "correct": true}, {"label": "C", "text": "TORCH infections", "correct": false}, {"label": "D", "text": "Gestational diabetic mellitus", "correct": false}], "correct_answer": "B. Antiphospholipid antibody syndrome", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:674px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Laboratory Criteria</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Obstetrical:</strong></p>\n<ul>\n<li>≥3 unexplained consecutive <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">spontaneous</span> miscarriages &lt; 10 weeks gestation</li>\n<li>≥1 unexplained <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> death(s) ≥10weeks' gestation</li>\n<li>Severe <span class=\"customMeta\" data-dictid=\"1fa06d396c1692777196050a5db718\">preeclampsia</span> or <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> <span class=\"customMeta\" data-dictid=\"80feaae4b31692777190ea1ba3fc25\">insufficiency</span> necessitating delivery before 34 weeks</li>\n</ul>\n<p><strong>Vascular:</strong></p>\n<ul>\n<li>≥1 episode of arterial, venous, or small-vessel <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> in any tissue</li>\n</ul>\n</td>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Presence of <span class=\"customMeta\" data-dictid=\"ccd536a9071692777191f53538ca30\">lupus</span> <span class=\"customMeta\" data-dictid=\"b5fc7729f316927771817f809648f5\">anticoagulant</span> (ISTH guidelines)</li>\n<li>Medium/high <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> levels of <span class=\"customMeta\" data-dictid=\"2d9b37c62116927771891f3784d2c8\">IgG</span> or <span class=\"customMeta\" data-dictid=\"e4a6fd7fbb169277718986a699e800\">IgM</span> anticardiolipin antibodies</li>\n<li>Anti-β2 glycoprotein-I <span class=\"customMeta\" data-dictid=\"2d9b37c62116927771891f3784d2c8\">IgG</span> or <span class=\"customMeta\" data-dictid=\"e4a6fd7fbb169277718986a699e800\">IgM</span> antibody</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:671px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>APS Subtype</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antithrombotic Therapy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>APS with prior thrombosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Start <span class=\"customMeta\" data-dictid=\"8dfaeedbf91692777200561b2b1d2f\">therapeutic</span> LMWH after confirming <span class=\"customMeta\" data-dictid=\"1d5d2712dc169277719050154d38a1\">intrauterine</span> pregnancy. (40 mg enoxaparin daily.)</li>\n<li>Begin low-dose <span class=\"customMeta\" data-dictid=\"deba671f4716927771828c95a320e5\">aspirin</span> (LDA) before or immediately upon pregnancy confirmation. (60 to 80 mg daily)</li>\n<li>Avoid oral anticoagulants and factor Xa inhibitors throughout pregnancy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>APS with pregnancy <span class=\"customMeta\" data-dictid=\"9b7604d5461692777192546af7cabd\">morbidity</span> but no prior thrombosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Prophylactic-dose LMWH or unfractionated <span class=\"customMeta\" data-dictid=\"050e27829716927771885eddb2620c\">heparin</span> upon confirmation of pregnancy,</li>\n<li>LDA (81 mg) as early as possible.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Patients with early or late pregnancy loss</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Prophylactic-dose LMWH or unfractionated heparin,</li>\n<li>LDA (81 mg) from before pregnancy or as soon as known</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Preeclampsia with severe features or <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> insufficiency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>LDA from before pregnancy or as soon as known,</li>\n<li>Consider LMWH in specific cases</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hydroxychloroquine</strong>: For <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> pregnancy loss despite standard therapy.</p>\n<p><strong>IVIG and Prednisone</strong>: For <span class=\"customMeta\" data-dictid=\"3790c638ab16927771970a0a41d3ab\">refractory</span> cases to reduce <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> pregnancy loss; low-dose <span class=\"customMeta\" data-dictid=\"5dff8e3fac1692777196f8c0c960f3\">prednisone</span> is preferred to minimise <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> and <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> risks.</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 26-year-old female patient came with a history of fatiguability and constipation for the past 1 year. She had a history of multiple blood transfusions after delivery 4 years ago. She has had a lactational failure and never regained her periods after the delivery. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Sheehan syndrome", "correct": true}, {"label": "B", "text": "Hypothyroidism", "correct": false}, {"label": "C", "text": "Premature ovarian failure", "correct": false}, {"label": "D", "text": "Delayed blood transfusion reaction", "correct": false}], "correct_answer": "A. Sheehan syndrome", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:578px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p>Definition</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Postpartum <span class=\"customMeta\" data-dictid=\"e0a48202721692777189b0bac4612e\">hypopituitarism</span> caused by <span class=\"customMeta\" data-dictid=\"567171ee391692777190bfb8dbeb3e\">ischemic necrosis</span> of the <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> following severe <span class=\"customMeta\" data-dictid=\"3d885759d516927771966b84bfa470\">postpartum</span> hemorrhage.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Symptoms</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Failure to lactate</li>\n<li>Hypotension</li>\n<li>Hypoglycemia</li>\n<li>Fatigue</li>\n<li>Amenorrhea</li>\n<li>Hypothyroidism</li>\n<li>Adrenal insufficiency</li>\n<li>Decreased libido</li>\n<li>Weight gain</li>\n<li>Cold intolerance</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diagnosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Clinical history of severe <span class=\"customMeta\" data-dictid=\"3d885759d516927771966b84bfa470\">postpartum</span> hemorrhage.</li>\n<li>Hormonal evaluation: Low levels of <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> hormones (prolactin, TSH, ACTH, LH, FSH, growth hormone).</li>\n<li>MRI: Empty sella<strong> </strong>or <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> size.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Treatment:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lifelong hormone replacement therapy (glucocorticoids, levothyroxine, estrogen-progesterone, growth hormone if needed)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Name the parasite whose microfilaria have a sheath with no nuclei at the tail end?", "options": [{"label": "A", "text": "Wuchereria bancrofti", "correct": true}, {"label": "B", "text": "Brugia malayi", "correct": false}, {"label": "C", "text": "Brugia timori", "correct": false}, {"label": "D", "text": "Mansonella prestans", "correct": false}], "correct_answer": "A. Wuchereria bancrofti", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/M2Eh6blVrpxWE9Z4VjUt1745402957.png", "https://image.prepladder.com/content/Bk4NgtjZK287JHAJQAGM1745402970.png", "https://image.prepladder.com/content/cAGq3NtxeYJJVBhuXqyS1745402982.png", "https://image.prepladder.com/content/43mVcUXmUsu1jMeQSygk1745402994.png", "https://image.prepladder.com/content/JPYfXG28XiICHP9fZzRU1745403008.png", "https://image.prepladder.com/content/t9y7NahdlZhi4lhOZ0ni1745403020.png", "https://image.prepladder.com/content/EiJeANNPQ5bUa5O7YeaD1745403031.png", "https://image.prepladder.com/content/WrPemchugR7vexKUG4HA1745403044.png", "https://image.prepladder.com/content/7K8ukSnYGUAMAQXCiwor1745403057.png", "https://image.prepladder.com/content/DNxPLUz5ZeJh2wGLQS4w1745403068.png", "https://image.prepladder.com/content/dompKu69uCZqZQbwYHKu1745403083.png", "https://image.prepladder.com/content/XTGGLG1RSP5pdCvvGqWU1745403092.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Species </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Wuchereria bancrofti </strong><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Brugia malayi</strong></p>\n<p style=\"text-align:center\"><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Loa loa</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Mansonella perstans</strong><strong> </strong></p>\n<p style=\"text-align:center\"><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Mansonella ozzardi</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Onchocerca volvulus</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Shape </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"127\" src=\"https://image.prepladder.com/content/M2Eh6blVrpxWE9Z4VjUt1745402957.png\" width=\"128\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"136\" src=\"https://image.prepladder.com/content/Bk4NgtjZK287JHAJQAGM1745402970.png\" width=\"136\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"133\" src=\"https://image.prepladder.com/content/cAGq3NtxeYJJVBhuXqyS1745402982.png\" width=\"133\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"129\" src=\"https://image.prepladder.com/content/43mVcUXmUsu1jMeQSygk1745402994.png\" width=\"129\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"133\" src=\"https://image.prepladder.com/content/JPYfXG28XiICHP9fZzRU1745403008.png\" width=\"133\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"134\" src=\"https://image.prepladder.com/content/t9y7NahdlZhi4lhOZ0ni1745403020.png\" width=\"134\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Posterior end </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"127\" src=\"https://image.prepladder.com/content/EiJeANNPQ5bUa5O7YeaD1745403031.png\" width=\"128\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"136\" src=\"https://image.prepladder.com/content/WrPemchugR7vexKUG4HA1745403044.png\" width=\"136\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"133\" src=\"https://image.prepladder.com/content/7K8ukSnYGUAMAQXCiwor1745403057.png\" width=\"133\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"129\" src=\"https://image.prepladder.com/content/DNxPLUz5ZeJh2wGLQS4w1745403068.png\" width=\"129\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"133\" src=\"https://image.prepladder.com/content/dompKu69uCZqZQbwYHKu1745403083.png\" width=\"133\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"130\" src=\"https://image.prepladder.com/content/XTGGLG1RSP5pdCvvGqWU1745403092.png\" width=\"130\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tail nuclei</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nuclei do not extend to the tip of the tail</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2 <span class=\"customMeta\" data-dictid=\"e6b47028191692777193eb698e43b6\">nuclei</span> at the tip of the tail</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nuclei <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> continuous rows in the tip of the tail</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nuclei extend to the tip of the tail</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nuclei do not extend to the tip of the tail</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nuclei do not extend to the tip of the tail</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sheath </strong></p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Sheathed</p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Unsheathed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Periodicity </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nocturnal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nocturnal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diurnal</p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nonperiodic</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Primary <span class=\"customMeta\" data-dictid=\"1f7e7543bc16927772015cdb525c2b\">Vector</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Culex, Anopheles, Aedes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mansonia spp., Anopheles</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chrysops spp.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Simulium spp.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Culicoides</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Culicoides</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the standard unit for measuring the brightness of light emitted from a single point source?", "options": [{"label": "A", "text": "Candela", "correct": true}, {"label": "B", "text": "Lux", "correct": false}, {"label": "C", "text": "Lambert", "correct": false}, {"label": "D", "text": "Lumen", "correct": false}], "correct_answer": "A. Candela", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Photometric Quantity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>SI Unit</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Common Usage</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Luminous Intensity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Brightness of a light source in a specific direction</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Candela (cd)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Used in lighting design, LED specifications</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Luminous Flux</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Total light emitted in all directions</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lumen (lm) (Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Used in bulb ratings, projector brightness</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Illuminance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Light received per unit area</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lux (lx)</strong> (lm/m²) <strong>(Option B ruled out)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Used in workplace lighting standards, photography</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Luminance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Perceived brightness of a surface emitting or reflecting light</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Nit (cd/m²)</strong> or <strong>Lambert (Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Used in display screens, road signs</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the case of a child presenting with pharyngitis, when a throat swab is collected and sent for culture, in which colored bin should the used swab be disposed of?", "options": [{"label": "A", "text": "Red", "correct": false}, {"label": "B", "text": "Yellow", "correct": true}, {"label": "C", "text": "White", "correct": false}, {"label": "D", "text": "Blue", "correct": false}], "correct_answer": "B. Yellow", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Color</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Category of Waste</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Examples</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Yellow</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Infectious waste</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Waste that may contain pathogens and poses a risk of infection.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Contaminated dressings, swabs, body fluids, soiled <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> items</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Red (Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Contaminated waste</strong> (non-infectious)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Waste that has been contaminated with bodily fluids but is not infectious.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Non-sharp waste like plastic, tubing, syringes (without needles), and items used in medical treatments</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Blue (Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Glass waste</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Waste consisting of broken glassware or other glass items.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Glass vials, ampoules, broken glass containers</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>White (Translucent) (Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sharp waste</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Waste items that can cut or puncture, requiring careful handling.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Needles, syringes with needles, scalpels, razors, and broken glass</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Black</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>General or non-biomedical waste</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Non-hazardous waste that is not contaminated by biological or medical waste.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Paper, packaging, non-infectious non-medical waste</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient was suspected of having acute brucellosis. A serum sample was sent for a standard agglutination test. It came out to be negative initially, but after serial dilutions of the serum sample, the test turned out to be positive. Which of the following is responsible for the initial negative test?", "options": [{"label": "A", "text": "Incomplete antibodies", "correct": false}, {"label": "B", "text": "Complement inactivation", "correct": false}, {"label": "C", "text": "Prozone phenomenon", "correct": true}, {"label": "D", "text": "Post zone phenomenon", "correct": false}], "correct_answer": "C. Prozone phenomenon", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Morphology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Biochemical Properties</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Growth &amp; Susceptibility</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Small, non-motile, aerobic, <span class=\"customMeta\" data-dictid=\"08cb2b02c81692777188b83845c84c\">Gram-negative</span> coccobacilli</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Catalase positive</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Do not grow well on standard laboratory media</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Non-capsulated and non-spore forming</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Oxidase positive (except<em> B. neotomae</em> and <em>B. ovis)</em></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Destroyed by heat at 60°C in 10 minutes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often exhibit a <span class=\"customMeta\" data-dictid=\"df4ae006fe1692777183604169e9b2\">bipolar</span> <span class=\"customMeta\" data-dictid=\"3b007026bd16927771997ae809b603\">staining</span> appearance</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Urease positive</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Killed by 1% <span class=\"customMeta\" data-dictid=\"0d5565e4a1169277719596227ebffd\">phenol</span> in 15 minutes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Utilize oxygen but do not typically <span class=\"customMeta\" data-dictid=\"9af2ec7d1c16927772021e06a81cb5\">ferment</span> carbohydrates</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Killed by pasteurization</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Key Points</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Standard <span class=\"customMeta\" data-dictid=\"36e1a07ab01692777180db73f01e84\">Agglutination</span> Test (SAT)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tube <span class=\"customMeta\" data-dictid=\"36e1a07ab01692777180db73f01e84\">agglutination</span> test using <span class=\"customMeta\" data-dictid=\"b02f35d9471692777198bf98bee1f7\">serial</span> dilutions of patient's <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> and killed B. <span class=\"customMeta\" data-dictid=\"08b6873cdf16927771808060833cc5\">abortus</span> antigen</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Significant titer: 160 or more.</li>\n<li>Acute <span class=\"customMeta\" data-dictid=\"9f660984cd1692777183b93d848da3\">brucellosis</span> titer: 640 or more within 3-4 weeks.</li>\n<li><strong>Prozone phenomenon common</strong>.</li>\n<li>False positives with cholera, tularemia, <span class=\"customMeta\" data-dictid=\"b98ea6f7ff1692777202949d7a5b46\">yersinia</span> infection, or immunization</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Complement <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">Fixation</span> Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Detects <span class=\"customMeta\" data-dictid=\"2d9b37c62116927771891f3784d2c8\">IgG</span> antibodies</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Valuable in chronic cases</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>ELISA (Enzyme-Linked <span class=\"customMeta\" data-dictid=\"9660c7ea2116927771894b30a0f80b\">Immunosorbent</span> Assay)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Distinguishes between <span class=\"customMeta\" data-dictid=\"e4a6fd7fbb169277718986a699e800\">IgM</span> and <span class=\"customMeta\" data-dictid=\"2d9b37c62116927771891f3784d2c8\">IgG</span> antibodies</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Useful for differentiating <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> from chronic infections</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Rapid Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Includes rapid <span class=\"customMeta\" data-dictid=\"1dd1a9a2f21692777186672cf2ab93\">dipstick</span> tests and <span class=\"customMeta\" data-dictid=\"b4346bc4021692777197ae44668edb\">Rose Bengal</span> card test</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Quick results.</li>\n<li>Can be used for initial screening</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Characteristic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Morphology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Small, non-motile, aerobic, <span class=\"customMeta\" data-dictid=\"08cb2b02c81692777188b83845c84c\">Gram-negative</span> coccobacilli, Non-capsulated, non-spore forming, <span class=\"customMeta\" data-dictid=\"df4ae006fe1692777183604169e9b2\">Bipolar</span> staining</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Biochemical Properties</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Catalase positive, <span class=\"customMeta\" data-dictid=\"4a14dfa14e1692777194882f818d87\">Oxidase</span> positive (except B. neotomae and B. ovis), <span class=\"customMeta\" data-dictid=\"f9076f5a1d1692777201e6af082c74\">Urease</span> positive, Utilize oxygen, do not <span class=\"customMeta\" data-dictid=\"9af2ec7d1c16927772021e06a81cb5\">ferment</span> carbohydrates</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Growth &amp; Susceptibility</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Do not grow well on standard media. Destroyed by heat at 60°C in 10 min, Killed by 1% <span class=\"customMeta\" data-dictid=\"0d5565e4a1169277719596227ebffd\">phenol</span> in 15 min, Killed by pasteurization.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Zoonotic Nature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Affects goats, sheep, cattle, buffaloes, pigs. Human infection through contact or consumption.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Intermittent fever, loss of appetite, nausea, <span class=\"customMeta\" data-dictid=\"9e2d8a3f5a16927771932c2348ec52\">muscular</span> and <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">articular</span> pains, fatigue, sweating, joint pain.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood Culture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Trypticase <span class=\"customMeta\" data-dictid=\"9264daf7031692777198ba5b8d6e8e\">soy</span> <span class=\"customMeta\" data-dictid=\"46988d61a21692777183ac440c691a\">broth</span> or <span class=\"customMeta\" data-dictid=\"1ce278e02d1692777183655ea881dc\">brucella</span> broth. <span class=\"customMeta\" data-dictid=\"d2d6148c9e16927771833a65ad15d2\">Biphasic</span> <span class=\"customMeta\" data-dictid=\"590c4f61381692777183624596f6ed\">blood culture</span> (Castaneda method). Large <span class=\"customMeta\" data-dictid=\"b9b690b70c16927771833aae799b33\">blood volume</span> (5 ml). Incubation: 37°C, 5-10% CO2, 6-8 weeks. 30-50% positive cases. <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">Bone marrow</span> cultureshave a higher yield.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serological Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>SAT: Significant <span class=\"customMeta\" data-dictid=\"07e6f3a1921692777200051f692a60\">titer</span> 160+, <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> 640+, <span class=\"customMeta\" data-dictid=\"f0ff39a3fa1692777184cf743ca1e7\">Complement</span> Fixation: <span class=\"customMeta\" data-dictid=\"2d9b37c62116927771891f3784d2c8\">IgG</span> detection, ELISA: Distinguishes <span class=\"customMeta\" data-dictid=\"e4a6fd7fbb169277718986a699e800\">IgM</span> &amp; IgG. Rapid Tests: Dipstick, Rose Bengal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Antibiotics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Adults: <span class=\"customMeta\" data-dictid=\"d0f202322516927771863db87b76e7\">Doxycycline</span> 45 days, <span class=\"customMeta\" data-dictid=\"39899c81f016927771991addbc683d\">Streptomycin</span> 2 weeks, Children: Cotrimoxazole + Rifampicin/Gentamycin.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vaccination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No human vaccine, Occupational risk: Attenuated live vaccine, Animals: B. <span class=\"customMeta\" data-dictid=\"08b6873cdf16927771808060833cc5\">abortus</span> strain 19 vaccine.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A researcher wants to know whether there is an association of CRP values with the risk of myocardial infarction/stroke. The study group was divided into quintiles and the following table is formed based on the study results. Which of the following statements is true regarding the relationship between CRP and the risk of myocardial infarction/stroke? Quintile CRP Values (mg/L) Relative Risk (RR) Study Population 1 0.1–1 1 6000 2 1.1–2 1.3 6000 3 2.1–3 1.7 6000 4 3.1–4 2.1 6000 5 4.1–5 2.8 6000", "options": [{"label": "A", "text": "CRP has no association with risk of Ml/stroke", "correct": false}, {"label": "B", "text": "Increase in CRP increases the risk of Ml/stroke", "correct": true}, {"label": "C", "text": "Increase in CRP decreases the risk of Ml/stroke", "correct": false}, {"label": "D", "text": "In quintile 1, there is no risk of Ml/stroke", "correct": false}], "correct_answer": "B. Increase in CRP increases the risk of Ml/stroke", "question_images": [], "explanation_images": [], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ In quintile 1, there is no risk of MI/stroke (Option D)</li><li>↳ 1</li><li>↳ no risk</li></ul>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:314px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Quintile</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>CRP (mg/L)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Relative Risk (RR)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>0.1–1.0</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1.0 (Baseline)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1.1–2.0</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1.3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2.1–3.0</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1.7</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3.1–4.0</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2.1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>5</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4.1–5.0</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2.8</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following indicators is not included in the Global Hunger Index (GHI) ?", "options": [{"label": "A", "text": "Infant mortality rate", "correct": true}, {"label": "B", "text": "Under-5 mortality rate", "correct": false}, {"label": "C", "text": "Percentage of undernourished population", "correct": false}, {"label": "D", "text": "Percentage of undernourished children under 5 years", "correct": false}], "correct_answer": "A. Infant mortality rate", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient who was on steroids for the treatment of chronic urticaria presents to the emergency department with acute worsening of respiratory symptoms. He says that he has been having a nocturnal cough for the last several weeks. A hemogram revealed elevated eosinophils. Bronchoalveolar lavage (BAL) specimen following bronchoscopy showed the presence of certain larvae as shown in the image below. Identify the causative organism.", "options": [{"label": "A", "text": "Ancylostoma caninum", "correct": false}, {"label": "B", "text": "Capillaria philippinensis", "correct": false}, {"label": "C", "text": "Strongylodes stercoralis", "correct": true}, {"label": "D", "text": "Enterobius vermicularis", "correct": false}], "correct_answer": "C. Strongylodes stercoralis", "question_images": ["https://image.prepladder.com/notes/Yt0rpr4dPMdVjdnWvA401746436366.png"], "explanation_images": ["https://image.prepladder.com/notes/7euHHTY6TWWDxJoMxext1746436462.png", "https://image.prepladder.com/notes/isYQz3BuCGOlE1r6ZsKY1746436492.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Rhabditiform larva</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Filariform larva</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Rhabditiform Larvae\" data-author=\"CDC Division of Parasitic Diseases\" data-hash=\"11845\" data-license=\"Open access\" data-source=\"https://www.cdc.gov/dpdx/strongyloidiasis/index.html\" data-tags=\"May2025\" height=\"209\" src=\"https://image.prepladder.com/notes/7euHHTY6TWWDxJoMxext1746436462.png\" width=\"283\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Filariform Larvae\" data-author=\"CDC Division of Parasitic Diseases\" data-hash=\"11848\" data-license=\"Open access\" data-source=\"https://www.cdc.gov/dpdx/strongyloidiasis/index.html\" data-tags=\"May2025\" height=\"219\" src=\"https://image.prepladder.com/notes/isYQz3BuCGOlE1r6ZsKY1746436492.png\" width=\"280\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1st stage</strong> of the <span class=\"customMeta\" data-dictid=\"48bab7934a16927771917c5a2bf7e2\">larva</span> (L1).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3d stage</strong> of the <span class=\"customMeta\" data-dictid=\"48bab7934a16927771917c5a2bf7e2\">larva</span> (L3).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Formed when eggs hatch in the small intestine.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Developed from two molts of the L1 larva.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Measures approximately 0.25 mm in length with a short muscul’ar <strong>double-bulb esophagus</strong>.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Measures about 0.55 mm in length, characterized by a long, slender shape, <strong>uniform esophagus</strong> &amp; <strong>notched tail</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Found in<strong> feces</strong>.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Seen in <strong>hyperinfection</strong> &amp; <strong>disseminated infection</strong> may show in sputum, <span class=\"customMeta\" data-dictid=\"44335bb8bf1692777199a956cb31bf\">stool</span> and body fluids.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic</strong> form</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Infective</strong> form</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Pathogenesis and Clinical Features of Strongyloides Stercoralis Infection</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Effect of Migrating Larvae</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Asymptomatic Infection</strong>: Over 50% may be asymptomatic.</li>\n<li><strong>Rashes</strong>: Recurrent <span class=\"customMeta\" data-dictid=\"a4fdae630a16927771918eaa32d28b\">maculopapular</span> or urticarial rashes on buttocks, perineum, and thighs.</li>\n<li><strong>Cutaneous <span class=\"customMeta\" data-dictid=\"48bab7934a16927771917c5a2bf7e2\">Larva</span> Migrans</strong>: Serpiginous <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> (larva currens) advancing up to 10 cm/hour.</li>\n<li><strong>Pulmonary Symptoms</strong>: Rare, mainly in chronic obstructive lung disease.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Effects of Adult Worms &amp; <span class=\"customMeta\" data-dictid=\"7212bc0b761692777202ff3be51de7\">Filariform</span> Larvae</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Mild to Moderate Load</strong>: Epigastric pain, nausea, diarrhea, constipation, and blood loss.</li>\n<li><strong>Heavy Larval Load</strong>: Risk of <span class=\"customMeta\" data-dictid=\"08cffc5d3e1692777189b33ea43a45\">hyperinfection</span> syndrome and <span class=\"customMeta\" data-dictid=\"f4006059f916927771865569d4da7d\">disseminated</span> strongyloidiasis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Hyperinfection Syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Cause</strong>: Repeated <span class=\"customMeta\" data-dictid=\"74448fc4d816927771823d36838fc8\">autoinfection</span> leads to increased <span class=\"customMeta\" data-dictid=\"7212bc0b761692777202ff3be51de7\">filariform</span> larvae.</li>\n<li><strong>Risk Factors</strong>: Glucocorticoid therapy, <span class=\"customMeta\" data-dictid=\"c3c986cd721692777189b473814b2e\">immunosuppressive</span> conditions, HTLV-1/HIV coinfection.</li>\n<li><strong>Features</strong>: Colitis, enteritis, malabsorption, possible <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> to <span class=\"customMeta\" data-dictid=\"f4006059f916927771865569d4da7d\">disseminated</span> strongyloidiasis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Disseminated Strongyloidiasis</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Pathophysiology</strong>: <span class=\"customMeta\" data-dictid=\"c2907c9f0016927771914eedf733dd\">Larvae</span> invade GIT and other organs. Disrupted <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> may allow <span class=\"customMeta\" data-dictid=\"85c304623c1692777187da4d1f1ee7\">enteric</span> <span class=\"customMeta\" data-dictid=\"0af84af4761692777202fbf6914573\">flora</span> to cause bacterial sepsis, pneumonia, or meningitis.</li>\n<li><strong>Clinical Manifestations</strong>: CNS invasion, brain abscesses, meningitis; <span class=\"customMeta\" data-dictid=\"c2907c9f0016927771914eedf733dd\">larvae</span> in CSF. <strong>Eosinophilia</strong>, often absent in severe cases.</li>\n<li><strong>Mortality Rate</strong>: Nearing 100% untreated; over 25% even with treatment.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><br/>\n<br/>\n<br/>\n\t\t\t \n\t\t\t<p><strong>Laboratory Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stool Microscopy</strong>: <span class=\"customMeta\" data-dictid=\"04f0aab5b4169277719786f163dc35\">Rhabditiform</span> larvae; requires multiple samples (4+) for accurate diagnosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Microscopy of Other Specimens</strong>: Entero-test for duodenal aspirates; high <span class=\"customMeta\" data-dictid=\"7212bc0b761692777202ff3be51de7\">filariform</span> <span class=\"customMeta\" data-dictid=\"c2907c9f0016927771914eedf733dd\">larvae</span> are found in stool, sputum, and tissue biopsies for <span class=\"customMeta\" data-dictid=\"f4006059f916927771865569d4da7d\">disseminated</span> cases.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stool Culture</strong>: Differentiates <span class=\"customMeta\" data-dictid=\"04f0aab5b4169277719786f163dc35\">rhabditiform</span> from <span class=\"customMeta\" data-dictid=\"2db7faaac316927771894a9f7f00bc\">hookworm</span> larvae.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serology</strong>: ELISA for antibodies; may show cross-reactivity, less effective for recent infections.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Coproantigen Detection</strong>: <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">Antigen</span> capture ELISA specific to Strongyloides.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Molecular Diagnosis</strong>: Real-time PCR <span class=\"customMeta\" data-dictid=\"e4865847fa169277720044d7b530b0\">targeting</span> specific genes.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4><strong>Treatment</strong></h4>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Asymptomatic Treatment</strong>: <span class=\"customMeta\" data-dictid=\"b16cf4486b169277719978dfa3e124\">Strongyloidiasis</span> should be treated regardless of symptoms due to the risk of hyperinfection.</li>\n<li><strong>Ivermectin</strong> (200 mg/kg daily for 2 days)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Nematode</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Infective form</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Route </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ascaris (Roundworm)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Embryonated eggs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fecal-oral</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Enterobius (Pinworm)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Embryonated eggs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fecal-oral</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Trichuris trichiura</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Embryonated eggs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fecal-oral</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ancylostoma (Hookworm)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Filariform larva</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Skin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Strongyloides Stercoralis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Filariform larva</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Skin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Trichinella spiralis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Encysted larva</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Carnivorism</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dracunculus medinensis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>L3 larva</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ingestion of infected Cyclops</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient admitted with 50% burns develops an infection at the burn site. The swab was cultured, the isolate is a strict aerobe and the test shown in the image is positive. What is the likely etiology of the burn infection?", "options": [{"label": "A", "text": "Klebsiella", "correct": false}, {"label": "B", "text": "Escherichia coli", "correct": false}, {"label": "C", "text": "Pseudomonas aeruginosa", "correct": true}, {"label": "D", "text": "Salmonella", "correct": false}], "correct_answer": "C. Pseudomonas aeruginosa", "question_images": ["https://image.prepladder.com/notes/8KuJtOJVTey6azZRfTX61746453552.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Organism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Morphology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Associated Diseases</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Neisseria </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gram-negative diplococci</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gonorrhea, Meningitis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Pseudomonas </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gram-negative rods</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Opportunistic infections, Pneumonia, UTI</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Vibrio </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gram-negative comma-shaped rods</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cholera, Gastroenteritis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Moraxella</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gram-negative diplococci</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Respiratory infections (e.g., <span class=\"customMeta\" data-dictid=\"b913f965781692777194c867946afe\">otitis</span> media, sinusitis)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Campylobacter </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gram-negative curved rods</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gastroenteritis (Campylobacter jejuni)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Aeromonas</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gram-negative rods</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Wound infections, Gastroenteritis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Helicobacter </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gram-negative <span class=\"customMeta\" data-dictid=\"0b34a9891d16927771998a84595013\">spiral</span> rods</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Peptic ulcers, Gastritis (H. pylori)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Legionella </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gram-negative rods</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Legionnaires' disease</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Brucella</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gram-negative coccobacilli</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Brucellosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Haemophilus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gram-negative coccobacilli</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pneumonia, <span class=\"customMeta\" data-dictid=\"b913f965781692777194c867946afe\">Otitis</span> media, Epiglottitis, Meningitis, <span class=\"customMeta\" data-dictid=\"3207c2541a1692777198f4af88308b\">Sinusitis</span> (H. Influenzae)</p>\n<p>Chancroid (H. Ducreyi)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Bordetella</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gram-negative coccobacilli</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pertussis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which type of thermometer is employed to assess the low air velocity rather than the cooling efficiency of the air?", "options": [{"label": "A", "text": "Kata thermometer", "correct": true}, {"label": "B", "text": "Globe thermometer", "correct": false}, {"label": "C", "text": "Wet globe thermometer", "correct": false}, {"label": "D", "text": "Dial thermometer", "correct": false}], "correct_answer": "A. Kata thermometer", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Thermometer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Purpose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Measures</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Kata thermometer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Low air velocity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rate of heat loss from a heated bulb</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Globe thermometer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Radiant heat</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Temperature considering radiation from surroundings</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Wet globe thermometer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Thermal comfort index</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Combination of air temperature, humidity, and <span class=\"customMeta\" data-dictid=\"e042c37d881692777197155713288b\">radiant</span> heat</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dial thermometer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>General temperature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Direct air or surface temperature</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "One week after having unprotected sexual intercourse, a 25-year-old male develops urethral discharge as shown in the image below. What is the most likely causative organism for this condition?", "options": [{"label": "A", "text": "Neisseria gonorrheae", "correct": true}, {"label": "B", "text": "Ureplasma urealyticum", "correct": false}, {"label": "C", "text": "Herpes simplex virus", "correct": false}, {"label": "D", "text": "Trichomonas vaginalis", "correct": false}], "correct_answer": "A. Neisseria gonorrheae", "question_images": ["https://image.prepladder.com/notes/IzFSdOBgIx3HHX7wAZDX1746437007.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Neisseria Gonorrhoeae</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Men</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Urethritis, <span class=\"customMeta\" data-dictid=\"0c02372a7d1692777196974ab1d772\">purulent</span> urethral discharge, dysuria, epididymitis, prostatitis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Women</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cervicitis, <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> discharge, <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> disease (PID), dysuria, and <span class=\"customMeta\" data-dictid=\"38d81995a71692777190221fdbb893\">intermenstrual</span> bleeding.</p>\n<p>Rarely can cause Fitz-Hugh-Curtis syndrome.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pharyngeal Infection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often asymptomatic, <span class=\"customMeta\" data-dictid=\"0d8cd9c1b516927771981287d4850f\">sore</span> throat, pharyngitis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rectal Infection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Proctitis, rectal discharge, pain, and tenesmus, may be asymptomatic.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Disseminated Gonococcal Infection (DGI)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fever, dermatitis, polyarthralgia, <span class=\"customMeta\" data-dictid=\"39f67d7dde16927771985d3952058d\">septic</span> arthritis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neonates</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ophthalmia neonatorum, conjunctivitis, potential for <span class=\"customMeta\" data-dictid=\"cf284485b71692777183c57876bed2\">blindness</span> if untreated.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Diagnosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gram Stain</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gram-negative <span class=\"customMeta\" data-dictid=\"32537c6fb21692777186a27701e42b\">diplococci</span> within <span class=\"customMeta\" data-dictid=\"0d0b0bf80b1692777196a0d5a44e03\">polymorphonuclear</span> leukocytes (particularly useful in men).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Culture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thayer-Martin or other selective media, oxidase-positive, and carbohydrate <span class=\"customMeta\" data-dictid=\"6aee31718c16927772019237286270\">utilization</span> tests.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>NAAT (Nucleic Acid Amplification Test)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Highly sensitive and specific, recommended for urogenital, pharyngeal, and rectal specimens.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Serological Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Not commonly used due to lower sensitivity and <span class=\"customMeta\" data-dictid=\"e70dd3ea9916927771988faba61d64\">specificity</span> compared to NAAT and culture.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment- Green STD kit</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>First-Line Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ceftriaxone 500 mg IM as a single dose PLUS <span class=\"customMeta\" data-dictid=\"d0f202322516927771863db87b76e7\">doxycycline</span> 100 mg orally twice daily for 7 days (if <span class=\"customMeta\" data-dictid=\"c696543c5e1692777184664ef12c39\">chlamydial</span> co-infection is not excluded).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Alternative Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gentamicin 240 mg IM as a single dose PLUS <span class=\"customMeta\" data-dictid=\"765229d44a1692777182fb0343abf4\">azithromycin</span> 2 g orally as a single dose (if ceftriaxone is not available).</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The ultrasound of a young woman with infertility is suggestive of a uterine anomaly. Which of the following is used to confirm the diagnosis?", "options": [{"label": "A", "text": "Hysterosalpingography", "correct": false}, {"label": "B", "text": "Hysteroscopy + laparoscopy", "correct": true}, {"label": "C", "text": "Laparoscopy", "correct": false}, {"label": "D", "text": "Transvaginal sonography", "correct": false}], "correct_answer": "B. Hysteroscopy + laparoscopy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Considering the immune status of a girl child who has been experiencing repeated yeast infections and respiratory virus infections since the age of 3 months, which vaccine should be avoided?", "options": [{"label": "A", "text": "Killed IPV", "correct": false}, {"label": "B", "text": "Measles/MMR", "correct": true}, {"label": "C", "text": "DPT", "correct": false}, {"label": "D", "text": "TT/Td", "correct": false}], "correct_answer": "B. Measles/MMR", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Vaccine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Route</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Site</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type of Vaccine</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>BCG</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>At birth (up to 1 year)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intradermal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Left upper arm</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Live attenuated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hepatitis B (Birth Dose)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>At birth (within 24 hrs)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intramuscular</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anterolateral thigh</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inactivated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>OPV (Zero Dose)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>At birth (within 15 days)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Oral</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Live attenuated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pentavalent (DPT + Hib + <span class=\"customMeta\" data-dictid=\"d3d938151416927771887e91804b5b\">Hep</span> B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6, 10, 14 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intramuscular</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anterolateral thigh</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>DPT (toxoid), Hib &amp; <span class=\"customMeta\" data-dictid=\"d3d938151416927771887e91804b5b\">Hep</span> B (inactivated)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>OPV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6, 10, 14 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Oral</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Live attenuated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Rotavirus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6, 10, 14 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Oral</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Live attenuated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>IPV (Fractional)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6 &amp; 14 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intradermal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Right upper arm</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inactivated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>PCV (Pneumococcal <span class=\"customMeta\" data-dictid=\"2421c657771692777185af1b7b59c3\">Conjugate</span> Vaccine)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6, 14 weeks, and 9 months</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intramuscular</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anterolateral thigh</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Conjugate</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Measles &amp; <span class=\"customMeta\" data-dictid=\"b8aa1ffb8916927771976438d71d1b\">Rubella</span> (MR) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>9-12 months &amp; 16-24 months</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Subcutaneous</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Right upper arm</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Live attenuated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>JE (Japanese Encephalitis)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>9-12 months &amp; 16-24 months</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Subcutaneous</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Left upper arm</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Live attenuated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>DPT Booster-1 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>16-24 months</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intramuscular</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anterolateral thigh</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Toxoid</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>OPV Booster</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>16-24 months</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Oral</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Live attenuated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>PCV Booster</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>9-12 months</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intramuscular</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anterolateral thigh</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Conjugate</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Measles/MR Booster</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>16-24 months</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Subcutaneous</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Right upper arm</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Live attenuated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>DPT Booster-2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>5-6 years</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intramuscular</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Deltoid</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Toxoid</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>TT (Tetanus Toxoid)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>10 years &amp; 16 years</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intramuscular</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Deltoid</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Toxoid</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cervical Cancer (HPV)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>9-14 years (girls)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intramuscular</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Deltoid</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Recombinant</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 26-year-old pregnant woman, on examination, was found to have infra-umbilical flattening. The fetal heart sounds were heard over the lateral side. What could be the fetal presentation/ position?", "options": [{"label": "A", "text": "Brow", "correct": false}, {"label": "B", "text": "Knee", "correct": false}, {"label": "C", "text": "Occipitoposterior", "correct": true}, {"label": "D", "text": "Right dorso-anterior", "correct": false}], "correct_answer": "C. Occipitoposterior", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A primi at term presented with labor pain and multiple painful vesicular lesions on her vulva. No rashes were found on other parts of the body. What will be the management of this case?", "options": [{"label": "A", "text": "Acyclovir and elective Cesarean section", "correct": true}, {"label": "B", "text": "Acyclovir and induction of labor", "correct": false}, {"label": "C", "text": "Spontaneous delivery", "correct": false}, {"label": "D", "text": "Antiviral and normal vaginal delivery", "correct": false}], "correct_answer": "A. Acyclovir and elective Cesarean section", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is assessed by evaluating the patient's treatment and clinical management in a healthcare facility?", "options": [{"label": "A", "text": "Outcome", "correct": false}, {"label": "B", "text": "Process", "correct": true}, {"label": "C", "text": "Structure", "correct": false}, {"label": "D", "text": "Input", "correct": false}], "correct_answer": "B. Process", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Evaluation Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Focus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Purpose</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Structure Evaluation (Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Assesses the resources and organizational components of healthcare facilities.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Infrastructure, staff qualifications, medical equipment</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ensure the healthcare facility has adequate resources, equipment, and trained staff.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Process Evaluation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Assesses how healthcare services are delivered, <span class=\"customMeta\" data-dictid=\"fefa53d9f216927772037e31a651d7\">focusing</span> on procedures and practices.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clinical guidelines, care delivery methods, patient interactions</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ensure care is aligned with best practices and protocols.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Outcome Evaluation (Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Evaluates the results of healthcare interventions.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Health outcomes, symptom improvement, recovery, patient satisfaction</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Determine the effectiveness of treatments and interventions in improving health.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Input Evaluation (Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Assesses the resources available for healthcare.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Financial resources, staff levels, medical supplies</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ensure sufficient resources for effective healthcare delivery.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cost-Effectiveness Evaluation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Assesses whether the intervention provides good value for the cost.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cost relative to health outcomes, alternative treatments</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ensure the efficient use of resources and value for money in healthcare.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Patient-Centered Evaluation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Focuses on patient experience and satisfaction.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Patient satisfaction, provider-patient relationship, treatment understanding</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ensure care aligns with patient needs and improves their experience and compliance.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Component</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Key Focus Areas</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Relevance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Assesses whether the program addresses the priority health needs of the target population.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Disease burden, target group needs, <span class=\"customMeta\" data-dictid=\"3c0c325f4216927771819e5d0eb581\">alignment</span> with <span class=\"customMeta\" data-dictid=\"f42f73407916927771969cb688f953\">public health</span> goals.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Adequacy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Evaluates whether the resources and scale of the program are sufficient to achieve the intended outcomes.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Coverage, resource allocation, unmet needs.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Accessibility</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Measures how easily beneficiaries can access program services.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Geographic, financial, and cultural barriers to access.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Acceptability</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Determines whether the program is acceptable to beneficiaries and stakeholders.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Community participation, cultural compatibility, stakeholder feedback.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Equity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Assesses whether the program reduces disparities in health outcomes and services.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reach among marginalized populations, fairness in resource distribution.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Efficiency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Evaluates the <span class=\"customMeta\" data-dictid=\"208cf74d74169277719486afd05eb3\">optimal</span> use of resources to achieve desired outcomes.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cost-efficiency, time management, operational performance.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Effectiveness</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Measures the extent to which the program achieves its objectives and desired outcomes.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reduction in <span class=\"customMeta\" data-dictid=\"9b7604d5461692777192546af7cabd\">morbidity</span> and mortality, behavior changes, program goals met.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "There is an outbreak of acute encephalitis in the community and a vaccination drive is launched. Which of the following is true about the vaccine given in this condition?", "options": [{"label": "A", "text": "Killed and intramuscular", "correct": true}, {"label": "B", "text": "Live and subcutaneous", "correct": false}, {"label": "C", "text": "Live and intramuscular", "correct": false}, {"label": "D", "text": "Killed and subcutaneous", "correct": false}], "correct_answer": "A. Killed and intramuscular", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Vaccine Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Examples</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Route of Administration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Usage</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Inactivated (Killed)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>JEEV, IXIARO</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Intramuscular (IM)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Used in outbreaks &amp; travelers</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Live Attenuated</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>SA 14-14-2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Subcutaneous (SC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Routine immunization</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the probable cause in a case of tinea capitis where white powdery colonies were obtained from the hair specimen and the hair perforation test was positive on the isolate?", "options": [{"label": "A", "text": "Trichophyton rubrum", "correct": false}, {"label": "B", "text": "Trichophyton schoenleinii", "correct": false}, {"label": "C", "text": "Trichophyton mentagrophytes", "correct": true}, {"label": "D", "text": "Trichophyton violaceum", "correct": false}], "correct_answer": "C. Trichophyton mentagrophytes", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/mFdOBGOpRdThaDROZM9e1746437194.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Method</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Macroscopic examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Assess the growth rate, texture, and colour on media</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Urea <span class=\"customMeta\" data-dictid=\"41255286461692777189199a8b2dc7\">hydrolysis</span> test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Determines ability to <span class=\"customMeta\" data-dictid=\"e8b0f32bea1692777189564bb6678f\">hydrolyze</span> urea</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Growth on polished rice or special media</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tests the ability to grow in specific conditions</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Temperature tolerance test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Assesses resistance to elevated temperatures</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nutritional requirements test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Checks requirements for specific <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acids and vitamins</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old married woman came for an infertility evaluation. Upon further investigation, intramural fibroids of sizes 7x5cm and 5x3cm were seen at the right and left cornual ends of the uterus. Her husband's semen analysis was found to be normal. What is the appropriate management of this case?", "options": [{"label": "A", "text": "Uterine artery embolization", "correct": false}, {"label": "B", "text": "Myomectomy", "correct": true}, {"label": "C", "text": "Artificial reproductive techniques", "correct": false}, {"label": "D", "text": "GnRH analogues", "correct": false}], "correct_answer": "B. Myomectomy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:474px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hysteroscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Laparoscopy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fibroid of 3–4 cm in diameter</li>\n<li>Type 0 submucosal</li>\n<li>Type 1 submucosal</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Subserous</li>\n<li>Intramural fibroids</li>\n<li>Type 2 submucosal</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Instrument used</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Electrocautery</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Electro-diathermy</li>\n<li>Harmonics</li>\n<li>Laser</li>\n<li>Extracorporeal sutures</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the classification of the air quality index in Delhi station on November 23, based on the provided air pollution index chart for 4 consecutive days? Date AQI November 21 350 November 22 340 November 23 407 November 24 356", "options": [{"label": "A", "text": "Moderately polluted", "correct": false}, {"label": "B", "text": "Poor", "correct": false}, {"label": "C", "text": "Very poor", "correct": false}, {"label": "D", "text": "Severe", "correct": true}], "correct_answer": "D. Severe", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:498px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>AQI Range</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Health Impact</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>0-50</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Good</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Minimal impact</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>51-100</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Satisfactory</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Minor discomfort to sensitive people</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>101-200</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Moderate</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Discomfort to people with <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> diseases</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>201-300</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Poor</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Breathing discomfort for most people</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>301-400</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Very Poor</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Respiratory illness on prolonged exposure</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>401-500</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Severe</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Severe health impacts, emergency conditions</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>AQI Range</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Health Impact</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>0-50</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Good</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Minimal or no impact</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>51-100</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Satisfactory</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Minor discomfort for sensitive individuals</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>101-200</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Moderate</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Discomfort for people with <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> diseases</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>201-300</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Poor</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased discomfort, especially for children, elderly, and those with lung diseases</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>301-400</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Very Poor</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Respiratory illnesses on prolonged exposure</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>401-500</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Severe</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Serious health impacts, emergency conditions</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The Pathanamthitta district of Kerala was affected by floods and the government distributed doxycycline tablets for prophylaxis. Which other chemical will be distributed along with it?", "options": [{"label": "A", "text": "Zinc phosphide", "correct": false}, {"label": "B", "text": "Malathion", "correct": true}, {"label": "C", "text": "Lindane", "correct": false}, {"label": "D", "text": "Paris green", "correct": false}], "correct_answer": "B. Malathion", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:520px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Chemical</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Use</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Relevance in Floods</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Malathion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mosquito control (insecticide)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Prevents malaria, dengue</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Zinc phosphide</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rodenticide (kills rats)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Not used for mosquitoes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lindane</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Treats <span class=\"customMeta\" data-dictid=\"c6a796b2de16927771913a9977216c\">lice</span> and scabies</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Not relevant for floods</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Paris green</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Historical <span class=\"customMeta\" data-dictid=\"8fad75f63f1692777192f93996c6ab\">mosquito</span> larvicide</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Less commonly used today</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old married woman who is anxious to conceive presents with copious vaginal discharge, without any itching. Her last menstrual period was 13 days ago. What is the cause of her vaginal discharge?", "options": [{"label": "A", "text": "Candidiasis", "correct": false}, {"label": "B", "text": "Bacterial vaginosis", "correct": false}, {"label": "C", "text": "Trichomoniasis", "correct": false}, {"label": "D", "text": "Physiological", "correct": true}], "correct_answer": "D. Physiological", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the vector that causes the occurrence of buboes in the community?", "options": [{"label": "A", "text": "Xenopsylla cheopis", "correct": true}, {"label": "B", "text": "Phlebotomus argentipes", "correct": false}, {"label": "C", "text": "Ixodes tick", "correct": false}, {"label": "D", "text": "Female Anopheles mosquito", "correct": false}], "correct_answer": "A. Xenopsylla cheopis", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/yKWOc6LldIkjxbi4tJ4r1746437847.png", "https://image.prepladder.com/content/X2xOgDaO4LUZYdwv8RbM1745405940.png", "https://image.prepladder.com/notes/jakwPyFCPSrMCJ3yxg0X1746437974.png", "https://image.prepladder.com/content/wdISTP1xcHlfIYZQngd11745405948.png", "https://image.prepladder.com/content/bOdZXeMXVbOCsah37imQ1745405953.png", "https://image.prepladder.com/content/Oal5fP2RXOBsrPEONJoq1745405959.png", "https://image.prepladder.com/notes/yKWOc6LldIkjxbi4tJ4r1746437847.png", "https://image.prepladder.com/content/Gka9qfNj0b1k4Zt0hp021745405969.png", "https://image.prepladder.com/content/zmPYf9z6KWmbxw6yY2sL1745405973.png", "https://image.prepladder.com/content/SVyWf8iUfuQtm6FRHbPE1745405978.png", "https://image.prepladder.com/notes/UGg97jlMinoXmv4vnmJZ1746438132.png", "https://image.prepladder.com/content/t5NuTxL2SIKUIZolTgCK1745405987.png", "https://image.prepladder.com/notes/EYG2W9wKRj5yy7NFETet1746438248.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:1000px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Vector</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Identification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Habitat</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Malaria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Female Anopheles <span class=\"customMeta\" data-dictid=\"8fad75f63f1692777192f93996c6ab\">mosquito</span> (Option D ruled out)</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Photo Credit: James Gathany Content Providers(s): CDC\" data-hash=\"\" data-license=\"Open access\" data-source=\"https://commons.wikimedia.org/wiki/File:Anopheles_albimanus_mosquito.jpg\" data-tags=\"\" height=\"138\" src=\"https://image.prepladder.com/content/X2xOgDaO4LUZYdwv8RbM1745405940.png\" width=\"196\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Slender body, long legs, and dark-colored spots on wings.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Stagnant, clean water sources like ponds, lakes, and rice fields.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Transmits Plasmodium species causing malaria.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dengue</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Aedes aegypti</strong> and <strong>Aedes albopictus</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Aedes Aegypti\" data-author=\"Muhammad Mahdi Karim\" data-hash=\"11863\" data-license=\"GFDL 1.2\" data-source=\"https://commons.wikimedia.org/wiki/File:Aedes_aegypti_feeding.jpg\" data-tags=\"May2025\" height=\"92\" src=\"https://image.prepladder.com/notes/jakwPyFCPSrMCJ3yxg0X1746437974.png\" width=\"156\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>Aedes aegypti</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>White markings on legs, lyre-shaped pattern on the thorax.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Urban areas, especially around human dwellings and discarded containers.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Transmits <span class=\"customMeta\" data-dictid=\"75dc439beb16927771857bde5104df\">Dengue</span> virus causing <span class=\"customMeta\" data-dictid=\"75dc439beb16927771857bde5104df\">dengue</span> fever.</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Chikungunya</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Aedes aegypti</strong> and <strong>Aedes albopictus</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"James Gathany, CDC\" data-hash=\"\" data-license=\"Open access\" data-source=\"https://en.wikipedia.org/wiki/Aedes_albopictus#/media/File:CDC-Gathany-Aedes-albopictus-1.jpg\" data-tags=\"\" height=\"113\" src=\"https://image.prepladder.com/content/wdISTP1xcHlfIYZQngd11745405948.png\" width=\"200\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>Aedes albopictus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Similar to Aedes mosquitoes, with black and white banded legs.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Urban and suburban areas, especially in domestic settings.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Transmits Chikungunya virus, causing joint pain.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Japanese Encephalitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Culex mosquito</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"US Centers for Disease Control - City of Jacksonville, FL\" data-hash=\"\" data-license=\"Open access\" data-source=\"https://en.wikipedia.org/wiki/Culex#/media/File:CPipFm.jpg\" data-tags=\"\" height=\"154\" src=\"https://image.prepladder.com/content/bOdZXeMXVbOCsah37imQ1745405953.png\" width=\"122\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Smaller, brown or black, with a distinct <span class=\"customMeta\" data-dictid=\"0793729e511692777198412d5d1949\">scutellum</span> (plate-like structure).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ponds, marshes, and areas with <span class=\"customMeta\" data-dictid=\"00e90b2b491692777199a0547a1945\">stagnant</span> water.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Transmits Japanese <span class=\"customMeta\" data-dictid=\"9644652a1f16927771873765457fcc\">encephalitis</span> virus, causing encephalitis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Leishmaniasis (Kala-azar)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Phlebotomus argentipes</strong> (sandfly) <strong>(Option B ruled out)</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"CDC/ Frank Collins\" data-hash=\"\" data-license=\"Open access\" data-source=\"https://en.wikipedia.org/wiki/Phlebotominae#/media/File:Phlebotomus_pappatasi_bloodmeal_continue2.jpg\" data-tags=\"\" height=\"151\" src=\"https://image.prepladder.com/content/Oal5fP2RXOBsrPEONJoq1745405959.png\" width=\"167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Small, yellowish-brown, with a <span class=\"customMeta\" data-dictid=\"a4789768d21692777188e77f1969cd\">hairy</span> body and long legs.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sandy, dusty areas, often near human dwellings or animal shelters.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Transmits <span class=\"customMeta\" data-dictid=\"5dc59b3af1169277719191cbbe6447\">Leishmania</span> species causing visceral leishmaniasis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Bubonic Plague</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Xenopsylla cheopis</strong> (rat flea)</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Rat flea\" data-author=\"Olha Schedrina / The Natural History Museum \" data-hash=\"11859\" data-license=\"CC BY 4.0\" data-source=\"https://en.wikipedia.org/wiki/Oriental_rat_flea#/media/File:NHMUK010177265_The_plague_flea_-_Xenopsylla_cheopis_cheopis_(Rothschild,_1903).jpg\" data-tags=\"May2025\" height=\"123\" src=\"https://image.prepladder.com/notes/yKWOc6LldIkjxbi4tJ4r1746437847.png\" width=\"135\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Small, reddish-brown, flattened body.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Found on rats, especially in urban areas and during <span class=\"customMeta\" data-dictid=\"57d1018b9d1692777197393d47bd6a\">rodent</span> infestations.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Transmits Yersinia <span class=\"customMeta\" data-dictid=\"1db39f708f16927771954d003af865\">pestis</span> causing bubonic plague.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Filariasis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Female Culex mosquito</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"US Centers for Disease Control - City of Jacksonville, FL\" data-hash=\"\" data-license=\"Open access\" data-source=\"https://en.wikipedia.org/wiki/Culex#/media/File:CPipFm.jpg\" data-tags=\"\" height=\"190\" src=\"https://image.prepladder.com/content/Gka9qfNj0b1k4Zt0hp021745405969.png\" width=\"150\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Similar to Anopheles but with more rounded body and darker markings.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Stagnant water, especially in urban and rural areas.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Transmits Wuchereria bancrofti causing <span class=\"customMeta\" data-dictid=\"4fb6bd90f016927771918d4a2993ed\">lymphatic</span> filariasis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Zika Virus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Aedes mosquitoes</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"James Gathany, CDC\" data-hash=\"\" data-license=\"Open access\" data-source=\"https://en.wikipedia.org/wiki/Aedes_albopictus#/media/File:CDC-Gathany-Aedes-albopictus-1.jpg\" data-tags=\"\" height=\"113\" src=\"https://image.prepladder.com/content/zmPYf9z6KWmbxw6yY2sL1745405973.png\" width=\"200\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>Aedes albopictus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Similar to Aedes aegypti, black and white striped legs.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Urban and suburban areas, particularly in places with standing water.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Transmits Zika virus causing fever and birth defects.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tick-borne Encephalitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ixodes <span class=\"customMeta\" data-dictid=\"63b7807cc41692777200fab227369f\">tick</span> (Option C ruled out)</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Scott Bauer\" data-hash=\"\" data-license=\"OPEN ACCESS\" data-source=\"https://en.m.wikipedia.org/wiki/File:Adult_deer_tick(cropped).jpg\" data-tags=\"\" height=\"177\" src=\"https://image.prepladder.com/content/SVyWf8iUfuQtm6FRHbPE1745405978.png\" width=\"125\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Small, oval-shaped, with a flattened body.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Forested areas, grasslands, and areas with high animal populations.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Transmits Tick-borne <span class=\"customMeta\" data-dictid=\"9644652a1f16927771873765457fcc\">encephalitis</span> virus causing encephalitis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Rickettsial Diseases</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Rhipicephalus (dog tick)</strong> and other ticks</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Rhipicephalus (dog tick)\" data-author=\"NA\" data-hash=\"11869\" data-license=\"NA\" data-source=\"https://commons.wikimedia.org/wiki/File:Rhipicephalus_sanguineus.jpg\" data-tags=\"May2025\" height=\"183\" src=\"https://image.prepladder.com/notes/UGg97jlMinoXmv4vnmJZ1746438132.png\" width=\"151\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Oval, flat, with prominent mouthparts.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Grasslands, forests, and around domesticated animals.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Transmits Rickettsia bacteria causing typhus, scrub typhus, etc.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Malaria (P. falciparum)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Female Anopheles <span class=\"customMeta\" data-dictid=\"8fad75f63f1692777192f93996c6ab\">mosquito</span> (Option D ruled out)</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Photo Credit: James Gathany Content Providers(s): CDC\" data-hash=\"\" data-license=\"Open access\" data-source=\"https://commons.wikimedia.org/wiki/File:Anopheles_albimanus_mosquito.jpg\" data-tags=\"\" height=\"117\" src=\"https://image.prepladder.com/content/t5NuTxL2SIKUIZolTgCK1745405987.png\" width=\"167\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Same as <span class=\"customMeta\" data-dictid=\"8b4c650ddd1692777191286afbcd8a\">malaria</span> vector.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Found in areas with <span class=\"customMeta\" data-dictid=\"00e90b2b491692777199a0547a1945\">stagnant</span> water and human proximity.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Responsible for <strong>severe malaria</strong> (Plasmodium falciparum).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Scrub Typhus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Leptotrombidium mites (chiggers)</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Chigger - Larvae of tombiculid mite\" data-author=\"Sedhain, Arun &amp; Bhattarai, Gandhi. \" data-hash=\"11871\" data-license=\"CC BY NC SA 3.0\" data-source=\"https://www.researchgate.net/figure/Chigger-larva-of-trombiculid-mite_fig1_319060371\" data-tags=\"May2025\" height=\"158\" src=\"https://image.prepladder.com/notes/EYG2W9wKRj5yy7NFETet1746438248.png\" width=\"148\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Small, red, and often barely visible to the naked eye.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rural and semi-rural areas with dense vegetation.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Transmits Orientia tsutsugamushi causing scrub typhus.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient developed atonic postpartum hemorrhage after a normal vaginal delivery. She was shifted to the OT, and the obstetrician planned ligation of vessels to arrest the bleeding. What is the order of ligation of the blood vessels supplying the uterus?", "options": [{"label": "A", "text": "Uterine artery - Ovarian artery - Internal iliac artery", "correct": true}, {"label": "B", "text": "Uterine artery - Ovarian artery - External iliac artery", "correct": false}, {"label": "C", "text": "Uterine artery - Ovarian artery - Vaginal artery", "correct": false}, {"label": "D", "text": "Uterine artery - Pudendal artery - Vaginal artery", "correct": false}], "correct_answer": "A. Uterine artery - Ovarian artery - Internal iliac artery", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A teenage patient presented with a history of dysmenorrhea and chronic pelvic pain. On ultrasonography, a transverse vaginal septum was seen. What is the most common complication that can be seen in this patient?", "options": [{"label": "A", "text": "Endometriosis", "correct": true}, {"label": "B", "text": "Tubo-ovarian abscess", "correct": false}, {"label": "C", "text": "Dermoid cyst", "correct": false}, {"label": "D", "text": "Theca lutein cyst", "correct": false}], "correct_answer": "A. Endometriosis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70-year-old patient presented with cough, fatigue, and weight loss. He was diagnosed with squamous cell carcinoma on bronchoscopy. The resected specimen had a hilar lymph node that was 1 cm in size and showed a black pigment. What is the black pigment likely to be?", "options": [{"label": "A", "text": "Anthracotic pigment", "correct": true}, {"label": "B", "text": "Melanin", "correct": false}, {"label": "C", "text": "Lipochrome", "correct": false}, {"label": "D", "text": "Hemosiderin", "correct": false}], "correct_answer": "A. Anthracotic pigment", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/bgy4zLYMQ0KHMILGBYzF1746438770.png", "https://image.prepladder.com/notes/mwrORIiIxgjHncfwMtn91746438926.png", "https://image.prepladder.com/notes/Ic1ydr3xuVh5R1HaTxmN1746438842.png", "https://image.prepladder.com/notes/LoT1hZ0CfFbxyTPaB2Qz1746438888.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female patient recently diagnosed with tuberculosis was started on antitubercular therapy. Since she is using oral contraceptive pills, she was advised also to use a barrier method of contraception. Why was she given this advice?", "options": [{"label": "A", "text": "Teratogenicity of Antitubercular drugs", "correct": false}, {"label": "B", "text": "Failure of Antitubercular drugs", "correct": false}, {"label": "C", "text": "Rifampicin induces OCP metabolism and causes contraception failure", "correct": true}, {"label": "D", "text": "Rifampicin decreases OCP metabolism", "correct": false}], "correct_answer": "C. Rifampicin induces OCP metabolism and causes contraception failure", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Enzyme inducing drugs </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Enzyme inhibiting drugs </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Barbiturates</li>\n<li>Phenytoin</li>\n<li>Carbamazepine</li>\n<li>Rifampicin</li>\n<li>Cigarette smoking</li>\n<li>Chronic alcoholism</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Macrolides</li>\n<li>Azoles</li>\n<li>Chloramphenicol</li>\n<li>Omeprazole</li>\n<li>SSRI’s</li>\n<li>HIV <span class=\"customMeta\" data-dictid=\"fe13bbded1169277719694883c6ba4\">protease</span> inhibitors</li>\n<li>Cimetidine</li>\n<li>Metronidazole</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>P450 enzyme-inducing drugs </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>P450 <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">Enzyme</span> inhibiting drugs </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Barbiturates</li>\n<li>Phenytoin</li>\n<li>Carbamazepine</li>\n<li>Rifampicin</li>\n<li>Cigarette smoking</li>\n<li>Chronic alcoholism</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Macrolides</li>\n<li>Azoles</li>\n<li>Chloramphenicol</li>\n<li>Omeprazole</li>\n<li>SSRI’s</li>\n<li>HIV <span class=\"customMeta\" data-dictid=\"fe13bbded1169277719694883c6ba4\">protease</span> inhibitors</li>\n<li>Cimetidine</li>\n<li>Metronidazole</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old pregnant woman came for a routine antenatal checkup in her second trimester. Four years back, she delivered 2 healthy full-term twins. What would her obstetric score be?", "options": [{"label": "A", "text": "G2P2", "correct": false}, {"label": "B", "text": "G3P2", "correct": false}, {"label": "C", "text": "G2P1", "correct": true}, {"label": "D", "text": "G3P1", "correct": false}], "correct_answer": "C. G2P1", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gravida</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Denotes a pregnant state, both present and past, irrespective of the period of gestation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Parity</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Denotes a state of previous pregnancy beyond the period of viability(28 weeks)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abortion</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Number of pregnancies lost before 24 weeks</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Living</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Number of living children</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old male has been complaining of fatigue for the past year. The examination revealed massive splenomegaly. His blood workup shows the presence of anemia, TLC 150,000/microL, and PBS shows 60% neutrophils, 6% basophils, 4% eosinophils, myeloblasts, myelocytes, and metamyelocytes. The myeloid-to-erythroid ratio was 18:1. Which of the following is the most sensitive investigation in this case?", "options": [{"label": "A", "text": "Immunophenotyping", "correct": false}, {"label": "B", "text": "LAP score", "correct": false}, {"label": "C", "text": "FISH and PCR", "correct": true}, {"label": "D", "text": "Flow cytometry", "correct": false}], "correct_answer": "C. FISH and PCR", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/lUVaOefkGAKVYS0gsxty1745406603.png", "https://image.prepladder.com/content/VpSalZFvwAeXha83j9kP1745406612.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:664px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Investigations to find CML</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CBC</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Normal RBC + <strong>Elevated TLC + Elevated platelets </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Peripheral smear</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Left shift with predominant segmented neutrophils, myelocytes, and metamyelocytes.</li>\n<li><strong>College girl/garden party appearance.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Bone <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">marrow</span> aspirate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Increased</strong> Myeloid: Erythroid ratio.</li>\n<li><strong>Dwarf megakaryocytes. </strong></li>\n<li><strong>Sea blue histiocytes (blue-coloured cytoplasm)</strong></li>\n<li><strong>Pseudo Gaucher cells</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"MSoledad Noya, Marcio Andrade-Campos, Pilar Irun, Laura López de Frutos, MFernanda López-Fernandez, Pilar Giraldo\" data-hash=\"\" data-license=\"CC BY NC ND 4.0\" data-source=\"https://onlinelibrary.wiley.com/doi/full/10.1002/ccr3.1460\" data-tags=\"\" height=\"425\" src=\"https://image.prepladder.com/content/lUVaOefkGAKVYS0gsxty1745406603.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>NAP/LAP score</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The <strong>leukocyte <span class=\"customMeta\" data-dictid=\"b95c7f7b821692777181df660ee7ff\">alkaline</span> <span class=\"customMeta\" data-dictid=\"65f1c4f3d4169277719505249503e0\">phosphatase</span> (LAP) score</strong> is low in CML and can be used to <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> it from other leukaemias, but it’s not the most sensitive test. <strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>FISH (IOC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Confirms t(9:22) translocation.</li>\n<li>Analysis to quantify Philadelphia chromosome-positive cells.</li>\n<li>Estimates the tumour load.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Muhammad Asif, Mohammad Jamal ,Abdul Rehman Khan ,Muhammad Imran Naseer ,Abrar Hussain, Hani Choudhry, Dr. Arif Malik ,Shahida Aziz Khan ,Maged Mostafa Mahmoud ,Ashraf Ali, Saima Iram, Kashif Kamran, Asim Iqbal, Zainularifeen Abduljaleel, Peter Natesan Pushparaj, Mahmood Rasool\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Fluorescence-in-situ-hybridization-FISH-for-the-detection-of-922q34q11-BCR-ABL_fig2_301779737\" data-tags=\"\" height=\"367\" src=\"https://image.prepladder.com/content/VpSalZFvwAeXha83j9kP1745406612.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>PCR </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>To quantify BCR-ABL-1.</li>\n<li>It can be a false negative or a false positive.</li>\n<li>False negative: Early part of the disease.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 27-year-old woman who is on oral contraceptive pills for contraception has forgotten to take her pills on 4 different days in the last 2 weeks. She presents to the primary health centre, asking for advice. What would you suggest to her?", "options": [{"label": "A", "text": "Take 4 pills now, continue the schedule, and use a barrier method of contraception", "correct": false}, {"label": "B", "text": "Take 1 pill now, continue the schedule, and use a barrier method of contraception", "correct": false}, {"label": "C", "text": "Take 1 pill now, use a barrier method, and consider emergency contraception in case of recent intercourse", "correct": false}, {"label": "D", "text": "Discard the pack and start a new pack with an alternate method of contraception", "correct": true}], "correct_answer": "D. Discard the pack and start a new pack with an alternate method of contraception", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:647px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Number of Pills Missed</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Timing of Missed Pills</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Additional Considerations</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1 Pill</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anytime</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Take the missed pill as soon as remembered and continue the rest at the usual time ( Take two pills in one day).</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No additional <span class=\"customMeta\" data-dictid=\"ec56ec0a50169277718538a912cf18\">contraception</span> is needed. Emergency <span class=\"customMeta\" data-dictid=\"ec56ec0a50169277718538a912cf18\">contraception</span> (EC) is not required.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2 Consecutive Pills</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Week 1 or Week 2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Take the most recent missed pill as soon as remembered ( Take two pills in one day) and continue the rest as usual.</li>\n<li>Use backup <span class=\"customMeta\" data-dictid=\"ec56ec0a50169277718538a912cf18\">contraception</span> (e.g., condoms) for 7 days.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Consider EC if missed during Week 1 and unprotected sex occurred in the previous 5 days.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2 Consecutive Pills</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Week 3 or Week 4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Discard the current pack and start a new pack immediately.</li>\n<li>Use backup <span class=\"customMeta\" data-dictid=\"ec56ec0a50169277718538a912cf18\">contraception</span> for 7 days.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>_</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3 or More Consecutive Pills</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anytime</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Discard the current pack and start a new pack immediately.</li>\n<li>Use backup <span class=\"customMeta\" data-dictid=\"ec56ec0a50169277718538a912cf18\">contraception</span> for 7 days.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>_</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old female patient on treatment for infertility came with 6 weeks of amenorrhea, abdominal pain, and mild vaginal bleeding. Her beta hCG level was 2800 mlU/mL. On ultrasound, a 3cm mass was seen in the left adnexa. It contained a gestational sac with no fetal cardiac activity. What is the most appropriate management for this patient? hCG- Human Chronic Gonadotropin", "options": [{"label": "A", "text": "Expectant management", "correct": false}, {"label": "B", "text": "Single dose methotrexate", "correct": true}, {"label": "C", "text": "Salpingectomy", "correct": false}, {"label": "D", "text": "Milking of the tube", "correct": false}], "correct_answer": "B. Single dose methotrexate", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A girl presents with short stature, a webbed neck, thick calves, a shield-shaped chest, swelling of the ankle, and an increased carrying angle. What is the likely diagnosis?", "options": [{"label": "A", "text": "Turner syndrome", "correct": true}, {"label": "B", "text": "Down syndrome", "correct": false}, {"label": "C", "text": "Patau syndrome", "correct": false}, {"label": "D", "text": "Edward syndrome", "correct": false}], "correct_answer": "A. Turner syndrome", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/C9PK4lWlUjKKATNe9w0E1746439751.png", "https://image.prepladder.com/notes/HeEIixaIiNQsqBhjBbdy1746439909.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with fever, nocturnal cough, breathlessness, and wheezing for 4 weeks. The absolute eosinophil count is &amp;gt;5000/µL. Chest x-ray shows a miliary pattern. What is the likely diagnosis?", "options": [{"label": "A", "text": "Bronchial asthma", "correct": false}, {"label": "B", "text": "Miliary tuberculosis", "correct": false}, {"label": "C", "text": "Tropical pulmonary eosinophilia", "correct": true}, {"label": "D", "text": "Hypersensitivity pneumonitis", "correct": false}], "correct_answer": "C. Tropical pulmonary eosinophilia", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/9ZN7mzs3e5EMSNou7Nz91746439170.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with occupational exposure to benzene presents with repeated infections, easy fatigability, weight loss, and an evening rise in temperature. This occupational exposure will predispose him to which of the following cancers?", "options": [{"label": "A", "text": "Leukemia", "correct": true}, {"label": "B", "text": "Lung cancer", "correct": false}, {"label": "C", "text": "Bladder cancer", "correct": false}, {"label": "D", "text": "Skin cancer", "correct": false}], "correct_answer": "A. Leukemia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Risk of specific carcinomas related to specific exposure</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk of <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">carcinoma</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Occupation exposure </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lungs (Option B ruled out) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Arsenic, beryllium, cadmium, chromium, Asbestosis, Silica, radon, Nickel, and <span class=\"customMeta\" data-dictid=\"5bdef37bf01692777182f5780db753\">aromatic</span> hydrocarbon.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Bladder (Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Benzidine,</strong> Auramine, Beta-naphthylamine, <span class=\"customMeta\" data-dictid=\"d420f34d5816927771943f346531fc\">Para</span> amino-diphenyl, Magenta.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Liver </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Vinyl chloride</strong>, Arsenic.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Leukaemia </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Benzene</strong>, <span class=\"customMeta\" data-dictid=\"8e2fdef08316927771877389af9cc7\">ethylene</span> oxide.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Skin (Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Arsenic, ionising radiation, <span class=\"customMeta\" data-dictid=\"ce3cc4c1bd16927771967fba44f261\">Polycyclic</span> <span class=\"customMeta\" data-dictid=\"5bdef37bf01692777182f5780db753\">aromatic</span> hydrocarbons.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Scrotum </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Polycyclic <span class=\"customMeta\" data-dictid=\"5bdef37bf01692777182f5780db753\">aromatic</span> hydrocarbons.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/4lQ84daY8kvqxH2dmPpn1749401556.mp3", "video": ""}, {"text": "A patient with giant cell arteritis presented with headache, jaw claudication, polymyalgia rheumatica, and mononeuritis multiplex. What should be the first-line treatment for this patient?", "options": [{"label": "A", "text": "Abatacept", "correct": false}, {"label": "B", "text": "Tocilizumab", "correct": false}, {"label": "C", "text": "Steroids", "correct": true}, {"label": "D", "text": "Aspirin", "correct": false}], "correct_answer": "C. Steroids", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old male presents with complaints of episodes of palpitations, headache, and profuse sweating for the past few days. MIBG scan shows a deep-seated tumour in the adrenal medulla. Which of the following statements is incorrect regarding the condition described?", "options": [{"label": "A", "text": "Diagnosed by urine VMA &amp;amp; catecholamines", "correct": false}, {"label": "B", "text": "Surgical excision is the definitive treatment", "correct": false}, {"label": "C", "text": "Propranolol is given initially to manage hypertension", "correct": true}, {"label": "D", "text": "Can present as hypertension alone and sometimes with vomiting and pain abdomen", "correct": false}], "correct_answer": "C. Propranolol is given initially to manage hypertension", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ZZMtGSltLFROAnsRKX2g1745407683.png", "https://image.prepladder.com/content/L4kPhRFo36q9Balp9cyY1745407705.png", "https://image.prepladder.com/content/8WaUxO3HdLreFBrjUWsA1745407720.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Pheochromocytoma </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pheochromocytomas are rare tumours arising from <span class=\"customMeta\" data-dictid=\"6c4e8893871692777184b46d3381f5\">chromaffin</span> cells of the <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> medulla.</li>\n<li>The clinical features result from excessive <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> of catecholamines.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histopathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Histology of the <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> characteristically shows zellballen nests of <span class=\"customMeta\" data-dictid=\"6c4e8893871692777184b46d3381f5\">chromaffin</span> cells with strong positivity to chromogranin, synaptophysin, CD56, and focally to S100.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Nephron\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Paraganglioma#/media/File:Carotid_body_tumour_2_intermed_mag.jpg\" data-tags=\"\" height=\"267\" src=\"https://image.prepladder.com/content/ZZMtGSltLFROAnsRKX2g1745407683.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>The presence of <span class=\"customMeta\" data-dictid=\"6c4e8893871692777184b46d3381f5\">chromaffin</span> cells in the <span class=\"customMeta\" data-dictid=\"5d5198131c16927771873e61ef8092\">extra-adrenal</span> tissue is the only <span class=\"customMeta\" data-dictid=\"0e147ef62e1692777194c4761f6194\">pathognomonic</span> characteristic of the <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of the entity.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Classical <span class=\"customMeta\" data-dictid=\"1a0a43d74e16927772004473a05ae3\">triad</span> </strong>\n<ul>\n<li>Episode of palpitation</li>\n<li>Headache</li>\n<li>Profuse sweating</li>\n</ul>\n</li>\n<li><strong>The dominant sign is Hypertension</strong></li>\n<li><strong>Vomiting </strong><strong>(Option D)</strong></li>\n<li><strong>Pain abdomen</strong></li>\n<li>Tachycardia</li>\n<li>Anxiety</li>\n<li>Subcutaneous neurofibromas</li>\n<li>Cafe-au-lait macules</li>\n<li>Thyroid mass</li>\n<li>Axillary freckling</li>\n<li>Lisch nodules on the iris</li>\n<li>Retinal angiomas</li>\n<li>Abdominal mass</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Diagnosis of <span class=\"customMeta\" data-dictid=\"b0bdeae6a516927771954bdda95083\">pheochromocytoma</span> can be established by biochemical confirmation of <span class=\"customMeta\" data-dictid=\"0f03f178b51692777189f3658408a0\">hypersecretion</span> of metanephrines and catecholamines.</li>\n</ul>\n<p><strong>24-hour <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> test </strong></p>\n<ul>\n<li><strong>Catecholamines </strong><strong>(Option A)</strong></li>\n<li>Fractionated metanephrines</li>\n<li>Total metanephrines</li>\n<li><strong>Vanillylmandelic acid</strong> (VMA) (a <span class=\"customMeta\" data-dictid=\"fceb6bf8d01692777192b8b179f554\">metabolite</span> of <span class=\"customMeta\" data-dictid=\"35b6a8aeb416927771805fcc2e7dfb\">adrenaline</span> and noradrenaline) <strong>(Option A)</strong></li>\n</ul>\n<p><strong>Imaging</strong>:</p>\n<ul>\n<li>CT scan of the <span class=\"customMeta\" data-dictid=\"ac388c59831692777180f5a8e12913\">abdomen</span> and <span class=\"customMeta\" data-dictid=\"c25071fa3816927771955eeaf9d45e\">pelvis</span> to locate the tumour.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Gaillard F, Campos A, Weerakkody Y, et al. Pheochromocytoma. Reference article, Radiopaedia.org (Accessed on 29 Nov 2024) https://doi.org/10.53347/rID-8642\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/phaeochromocytoma-1\" data-tags=\"\" height=\"219\" src=\"https://image.prepladder.com/content/L4kPhRFo36q9Balp9cyY1745407705.png\" width=\"331\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>18F-FDG PET <span class=\"customMeta\" data-dictid=\"c497b556951692777198b599e4ba86\">scanning</span> is recommended for metastatic disease.</li>\n<li>MIBG scintigraphy</li>\n<li>Somatostatin <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> scintigraphy</li>\n<li>Gallium DOTATATE PET scanning</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"orge A. Carrasquillo, Clara C. Chen, Abhishek Jha, Alexander Ling, Frank I. Lin, Daniel A. Pryma and Karel Pacak Journal of Nuclear Medicine August 2021, 62 (8) 1033-1042; DOI: https://doi.org/10.2967/jnumed.120.259689\" data-hash=\"\" data-license=\"NA\" data-source=\"https://jnm.snmjournals.org/content/62/8/1033\" data-tags=\"\" height=\"280\" src=\"https://image.prepladder.com/content/8WaUxO3HdLreFBrjUWsA1745407720.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Differential Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hyperthyroidism</li>\n<li>Renal <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> stenosis</li>\n<li>Hyperaldosteronism</li>\n<li>Cardiomyopathy</li>\n<li>Postural <span class=\"customMeta\" data-dictid=\"af1cd978a41692777200da2f67bf22\">tachycardia</span> syndrome (POTS)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"32b854324a1692777185c6c79fdc99\">definitive</span> treatment of <span class=\"customMeta\" data-dictid=\"b0bdeae6a516927771954bdda95083\">pheochromocytoma</span> is <strong>surgical resection.</strong> <strong>(Option B)</strong></li>\n<li>Preoperative preparation of the patient has to be considered, and <span class=\"customMeta\" data-dictid=\"263ee5444e1692777183a7e8e704da\">blood pressure</span> should be consistently &lt; 160/90 mm Hg.</li>\n<li>Blood pressure is controlled by alpha-adrenergic blockers (phenoxybenzamine 0.5-4 mg/kg of body weight) <strong>(vs Option C)</strong></li>\n<li>Oral Prazosin or IV <span class=\"customMeta\" data-dictid=\"4b193b485f169277719585706f10f3\">phentolamine</span> can be used to control paroxysm.</li>\n</ul>\n<p><strong>Unilateral Pheochromocytoma:</strong></p>\n<ul>\n<li>Minimally <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> adrenalectomy: Preferred treatment for most <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> pheochromocytomas.</li>\n<li>Open adrenalectomy</li>\n</ul>\n<p><strong>Bilateral pheochromocytomas: </strong></p>\n<ul>\n<li>Bilateral total <span class=\"customMeta\" data-dictid=\"d111e1e6a116927771806eedcac2eb\">adrenalectomy</span> is associated with a lifelong need for <span class=\"customMeta\" data-dictid=\"a48ce797cd1692777199efc43b3e4c\">steroid</span> replacement with long-term side effects.</li>\n<li>Bilateral partial or <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> sparing <span class=\"customMeta\" data-dictid=\"d111e1e6a116927771806eedcac2eb\">adrenalectomy</span> (open or laparoscopic)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Myocardial infarction</li>\n<li>Cardiogenic shock</li>\n<li>Renal Failure</li>\n<li>Pulmonary edema</li>\n<li>Acute <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"afafb9026e1692777186e3dd168fa8\">distress</span> syndrome (ARDS)</li>\n<li>Lactic acidosis</li>\n<li>Hypertensive retinopathy</li>\n<li>Hypertensive encephalopathy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient who is a known case of atherosclerosis underwent a circumflex artery bypass. The stent is now placed successfully. He's already taking lisinopril, verapamil, and metoprolol. Which drug should be added?", "options": [{"label": "A", "text": "PDE 3 inhibitor", "correct": false}, {"label": "B", "text": "Direct oral anticoagulant", "correct": false}, {"label": "C", "text": "P2Y12 receptor blocker", "correct": true}, {"label": "D", "text": "PDE 5 inhibitor", "correct": false}], "correct_answer": "C. P2Y12 receptor blocker", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Percutaneous <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">Coronary</span> Intervention (PCI)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>PCI involves balloon <span class=\"customMeta\" data-dictid=\"29a08d8f9216927771869ed797367e\">dilatation</span> and stenting for <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> <span class=\"customMeta\" data-dictid=\"b72de43dd6169277718942f907b87c\">IHD</span> with suitable stenoses in epicardial <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> arteries.</p>\n<ul>\n<li><strong>Indications</strong>:\n\n\t\t\t\t<ul>\n<li>Symptom-limiting <span class=\"customMeta\" data-dictid=\"030cd51b341692777181d15302c8d4\">angina</span> despite <span class=\"customMeta\" data-dictid=\"208cf74d74169277719486afd05eb3\">optimal</span> medical therapy.</li>\n<li>Evidence of <span class=\"customMeta\" data-dictid=\"0f670d10711692777190af4b12fac9\">ischemia</span> during stress tests.</li>\n</ul>\n</li>\n<li><strong>Post-PCI Management</strong>:\n\t\t\t\t<ul>\n<li><strong>Aspirin </strong>is administered indefinitely, and <strong>P2Y12 antagonists</strong> for 1-3 months.</li>\n<li><strong>P2Y12 <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antagonists</strong><strong> </strong>are used with <span class=\"customMeta\" data-dictid=\"deba671f4716927771828c95a320e5\">aspirin</span> for up to 12 months.\n\t\t\t\t\t<ul>\n<li><strong>Clopidogrel</strong> (300mg, followed by 75 mg daily) with <span class=\"customMeta\" data-dictid=\"deba671f4716927771828c95a320e5\">aspirin</span> reduces death, reinfarction, and stroke risks in <span class=\"customMeta\" data-dictid=\"a4d4a0e12c1692777199cc73b5d6cc\">STEMI</span> patients.</li>\n<li>Newer drugs like <strong>ticagrelor </strong>(180 mg, followed by 90 mg twice daily)<strong> </strong>and <strong>prasugrel </strong>(60 mg, followed by 10 mg daily) are more effective than clopidogrel for ischemic <span class=\"customMeta\" data-dictid=\"8a6b09beac1692777184b08a2b5766\">complication</span> prevention in <span class=\"customMeta\" data-dictid=\"a4d4a0e12c1692777199cc73b5d6cc\">STEMI</span> patients undergoing <span class=\"customMeta\" data-dictid=\"0a263e27891692777194fb743083f9\">PCI</span> but have a higher <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> risk.</li>\n</ul>\n</li>\n<li>Current-generation<strong> drug-eluting stents</strong> reduce <span class=\"customMeta\" data-dictid=\"46b2c025701692777197ebd5938ea9\">restenosis</span> but require prolonged dual <span class=\"customMeta\" data-dictid=\"257da9409416927771815e64ee5df1\">antiplatelet</span> therapy (DAPT).</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A male patient had feeble femoral pulses with an upper-limb blood pressure of 186/90 mmHg. Chest x-ray showed enlarged intercostal arteries. What is the likely diagnosis?", "options": [{"label": "A", "text": "Coarctation of aorta", "correct": true}, {"label": "B", "text": "Atrial septal defect", "correct": false}, {"label": "C", "text": "Bicuspid aortic valve", "correct": false}, {"label": "D", "text": "Patent ductus arteriosus", "correct": false}], "correct_answer": "A. Coarctation of aorta", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with a seizure. On evaluation, urine osmolality is 1000 mOsm/kg, and serum osmolality is 270 mOsm/kg. Which electrolyte abnormality can be expected in this patient?", "options": [{"label": "A", "text": "Hypernatremia", "correct": false}, {"label": "B", "text": "Hyponatremia", "correct": true}, {"label": "C", "text": "Hyperkalaemia", "correct": false}, {"label": "D", "text": "Hypokalaemia", "correct": false}], "correct_answer": "B. Hyponatremia", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old patient with progressive painless loss of vision presents to the ophthalmology OPD. The fundus image of the patient is given below. What could be the probable finding and the cause of it?", "options": [{"label": "A", "text": "Soft exudate, hypertension", "correct": false}, {"label": "B", "text": "Hard exudate, diabetes mellitus", "correct": true}, {"label": "C", "text": "Flame-shaped hemorrhages, hypertension", "correct": false}, {"label": "D", "text": "Soft exudate, central retinal vein occlusion", "correct": false}], "correct_answer": "B. Hard exudate, diabetes mellitus", "question_images": ["https://image.prepladder.com/notes/ARmNUKTSri38jjMY385F1746440234.png"], "explanation_images": ["https://image.prepladder.com/notes/t6B6zvhcMGDK7025c3l11746440370.png", "https://image.prepladder.com/notes/q01JlLnJqmINhAvTkuC91746440391.png"], "explanation": "<p>Correct Answer B - Hard exudate, diabetes mellitus</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Soft Exudates (Cotton-Wool Spots)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Hard Exudates</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Cloud-like, small, ill-defined, whitish patches</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Bright yellow, well-defined <span class=\"customMeta\" data-dictid=\"a99114a6c216927771916f45ffc66c\">lipid</span> deposits</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Formation Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Caused by <span class=\"customMeta\" data-dictid=\"0f670d10711692777190af4b12fac9\">ischemia</span> and axonal swelling; <span class=\"customMeta\" data-dictid=\"43c30dc8c8169277718317ffb7dea0\">blockage</span> of axoplasmic flow</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Formed by leakage of fluid rich in proteins and lipids</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Superficial <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> layers, often seen around the <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> nerve</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Seen around leaking microaneurysms, especially in the macula</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Common Shape</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Indistinct and variable; may change shape quickly</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Radial, star-shaped figure in the <span class=\"customMeta\" data-dictid=\"948746a830169277719140f9f93879\">macula</span> (macular fan/star)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Main Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Hypertensive <span class=\"customMeta\" data-dictid=\"60029fa8cd169277719733357ef47e\">retinopathy</span> (Most common cause)</strong></li>\n<li>Diabetic retinopathy</li>\n<li>Toxemia of pregnancy</li>\n<li>Lupus erythematosus (LE)</li>\n<li>Polyarteritis nodosa (PAN)</li>\n<li>Retinopathy associated with AIDS</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Diabetic <span class=\"customMeta\" data-dictid=\"60029fa8cd169277719733357ef47e\">retinopathy</span> (Most common cause) (Option B)</strong></li>\n<li>Hypertensive retinopathy</li>\n<li>Coats' disease</li>\n<li>Circinate retinopathy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Image</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"Soft Exudates\" data-author=\"Yinghua Fu a, Ge Zhang a, Xin Lu a, Honghan Wu b,Dawei Zhang \" data-hash=\"11911\" data-license=\"NA\" data-source=\"https://www.sciencedirect.com/science/article/abs/pii/S0957417423014896\" data-tags=\"May2025\" height=\"290\" src=\"https://image.prepladder.com/notes/t6B6zvhcMGDK7025c3l11746440370.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Severe NPDR\" data-author=\"Mona Leeza, Humera Farooq\" data-hash=\"11913\" data-license=\"CC BY 3.0\" data-source=\"https://www.researchgate.net/figure/Pathological-images-with-labelled-anomalies_fig1_332293685\" data-tags=\"May2025\" height=\"300\" src=\"https://image.prepladder.com/notes/q01JlLnJqmINhAvTkuC91746440391.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What would be the suitable course of action for managing a 15-year-old girl who is non-adherent to wearing spectacles for her myopic astigmatism?", "options": [{"label": "A", "text": "LASIK", "correct": false}, {"label": "B", "text": "Spherical equivalent spectacles", "correct": true}, {"label": "C", "text": "Femto LASIK", "correct": false}, {"label": "D", "text": "Implantable collamer lens", "correct": false}], "correct_answer": "B. Spherical equivalent spectacles", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - Spherical equivalent spectacles</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Optical</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li><strong>Spectacles:</strong> with cylindrical power correction/<strong> spherical equivalent <span class=\"customMeta\" data-dictid=\"d5820e63b51692777198586cf21457\">spectacles</span> </strong>is the initial treatment option especially for paediatric age group <strong>(Option B)</strong></li>\n<li><strong>Rigid contact lenses:</strong> for up to 3D</li>\n<li><strong>Toric contact lenses:</strong> for &gt; 3D <span class=\"customMeta\" data-dictid=\"e0a7b7e6ec16927771826de64df66b\">astigmatism</span> cases</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Refractive Procedures</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Phototherapeutic keratectomy: </strong>Using excimer lens, for <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> astigmatism, can correct up to 3D</li>\n<li><strong>LASIK (Laser-Assisted <span class=\"customMeta\" data-dictid=\"96aaaa68ce1692777190096abe3c8a\">In Situ</span> Keratomileusis): </strong>can correct up to 5D</li>\n<li><strong>IOL implantation: </strong>Toric IOLs are preferred using Collamer lenses</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Surgical</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Penetrating or Deep <span class=\"customMeta\" data-dictid=\"95dc7047f41692777191f225afb261\">Lamellar</span> <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">Anterior</span> <span class=\"customMeta\" data-dictid=\"9810f0dbdb16927771908a955add6d\">Keratoplasty</span> (DLAK):</strong> in cases of corneal scarring/ no improvement with other treatment modalities</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 10-year-old child with AIDS presented with a fever and productive cough. On auscultation, bronchial breath sounds and crepitations were heard in the right infra-scapular region. Chest x-ray showed right lower lobe consolidation. The CD4 count was 55 cells/mm3. What is the most common causative organism for this condition?", "options": [{"label": "A", "text": "Pneumocystis jirovecii", "correct": false}, {"label": "B", "text": "Streptococcus pneumonia", "correct": true}, {"label": "C", "text": "Staphylococcus aureus", "correct": false}, {"label": "D", "text": "Mycoplasma", "correct": false}], "correct_answer": "B. Streptococcus pneumonia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4 style=\"text-align: center;\"><strong>Community-Acquired <span class=\"customMeta\" data-dictid=\"1000989d33169277719652247cd559\">Pneumonia</span> (CAP)</strong></h4>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<h4 style=\"text-align: center;\"><strong>Atypical Pneumonia</strong></h4>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Outpatients</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Hospitalised Patients</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Includes M.pneumoniae C.pneumoniae, and <span class=\"customMeta\" data-dictid=\"809c73827d1692777191fcf0d34805\">Legionella</span> species.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common causes:</strong></p>\n<p><strong>S.pneumoniae</strong>, M.pneumoniae</p>\n<p>H. influenzae, C.pneumoniae, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> viruses (influenza, RSV).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Non-ICU</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>ICU Patients</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Similar pathogens to outpatients, plus <span class=\"customMeta\" data-dictid=\"809c73827d1692777191fcf0d34805\">Legionella</span> species.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pathogens include S.pneumoniae, S. aureus (including MRSA), <span class=\"customMeta\" data-dictid=\"809c73827d1692777191fcf0d34805\">Legionella</span> species, <span class=\"customMeta\" data-dictid=\"08cb2b02c81692777188b83845c84c\">gram-negative</span> bacilli, and H. influenzae.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Staphylococcus aureus (MRSA)</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>It can cause CAP, often complicating <span class=\"customMeta\" data-dictid=\"c3817918b816927771902d2176d0c8\">influenza</span> infections.</li>\n<li>Community-acquired <span class=\"customMeta\" data-dictid=\"fdcadd75c416927771935379e47ef6\">MRSA</span> (CA-MRSA) has emerged as a significant cause of <span class=\"customMeta\" data-dictid=\"f826a1a46e1692777193319fa1e5ed\">necrotizing</span> pneumonia.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pneumococcal Pneumonia</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Higher risk in elderly patients, and those with comorbidities like dementia, heart failure, <span class=\"customMeta\" data-dictid=\"75a3b02a801692777184b9cb7f0c0a\">cerebrovascular</span> disease, alcoholism, smoking, COPD, and <span class=\"customMeta\" data-dictid=\"fa9d83d3d41692777189a8b393dd60\">HIV</span> infection.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CA-MRSA Pneumonia</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>More likely in patients with prior skin infections or following <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> illnesses.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Enterobacteriaceae</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Common in patients recently hospitalized, those treated with antibiotics, or those with comorbidities like alcoholism, heart failure, or <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pseudomonas aeruginosa</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Found in patients with severe structural lung diseases such as bronchiectasis, <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> fibrosis, or advanced COPD.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Legionella Infection</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Associated with risk factors like diabetes, hematologic malignancies, cancer, severe <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> disease, HIV, smoking, male gender, and recent travel (air conditioners, showers, hotels, cruise ships). It is an important cause of <span class=\"customMeta\" data-dictid=\"06123ff61a1692777182e19b790ebc\">atypical</span> pneumonia.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a patient, a 33-year-old female presents with symptoms of gradual vision loss specifically affecting the right halves of both eyes. The question pertains to the location of the lesion in the optic pathway.", "options": [{"label": "A", "text": "Left optic tract", "correct": true}, {"label": "B", "text": "Right visual cortex", "correct": false}, {"label": "C", "text": "Optic chiasma", "correct": false}, {"label": "D", "text": "Right optic nerve", "correct": false}], "correct_answer": "A. Left optic tract", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/XUEzEVgKjLH1aXEBN3q11745408814.png", "https://image.prepladder.com/content/m0M5fDKPCuNocNBqvwp61745408888.png", "https://image.prepladder.com/content/vco4NE3RLCRoGzjsnzAd1745408898.png", "https://image.prepladder.com/content/6wkip0hL9kZEp4T5x6o11745408903.png", "https://image.prepladder.com/content/DOUg9QEh17OdGadyL21x1745408911.png", "https://image.prepladder.com/content/hLPwF3BjCqyOuyQ8xrKN1745408918.png"], "explanation": "<p>Correct Answer A - Left &lt;span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\"&gt;optic&lt;/span&gt; tract</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Components of Visual Pathway</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Retina</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>First-order Neurons:</strong> <strong>Bipolar cells</strong> in the inner nuclear layer of the retina.</li>\n<li><strong>Second-order Neurons: <span class=\"customMeta\" data-dictid=\"bbd799518a169277718867e02de42f\">Ganglion</span> cells</strong> in the retina; their axons <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> the <strong>optic nerve</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Optic Nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Carries visual information from the <span class=\"customMeta\" data-dictid=\"f17d8978bd1692777197621051012f\">retina</span> to the <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> chiasm.</li>\n<li>Temporal and <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">Nasal</span> fibres of the same eye.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Optic Chiasma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Partial <span class=\"customMeta\" data-dictid=\"3dfb76e26c16927771855c6df807b9\">decussation</span> occurs</li>\n<li>Nasal fibres cross to the opposite side, while <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> fibres remain ipsilateral.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Optic Tract</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Carries visual information from the <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> <span class=\"customMeta\" data-dictid=\"e2cc97dc331692777184dee1ae5678\">chiasma</span> to the <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> <span class=\"customMeta\" data-dictid=\"00b4dbe9e4169277718881a95f7864\">Geniculate</span> body (LGB).</li>\n<li>Temporal fibres of the same eye and <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">Nasal</span> fibres of the opposite eye.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lateral <span class=\"customMeta\" data-dictid=\"00b4dbe9e4169277718881a95f7864\">Geniculate</span> Body (LGB)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Third Order Neurons:</strong> Relay visual information to the visual cortex.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Optic Radiations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Meyer's Loop: </strong>Carries information from lower <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> quadrants to the <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> part of the visual cortex.</li>\n<li><strong>Baum’s Loop (Dorsal): </strong>Carries information from upper <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> quadrants to the superior part of the visual cortex.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Occipital Cortex</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The primary visual <span class=\"customMeta\" data-dictid=\"cab8787ce916927771852a7e72f34d\">cortex</span> (V1), corresponding to <strong>Brodmann area 17</strong>, is situated on the <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> side of the <span class=\"customMeta\" data-dictid=\"77dc7a0ab81692777194dba7ab78ab\">occipital</span> lobe, particularly along the borders of the <span class=\"customMeta\" data-dictid=\"87c21c267916927771835c18842bb9\">calcarine</span> fissure.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Visual <span class=\"customMeta\" data-dictid=\"3aa5abc2fa169277719488e088076d\">Pathway</span> Lesions and Defects</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Site of Lesion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Fibers Affected</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Field Defect</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Optic Nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ipsilateral <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">Temporal</span> + <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">Nasal</span> Fibers</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"> </p>\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"191\" src=\"https://image.prepladder.com/content/m0M5fDKPCuNocNBqvwp61745408888.png\" width=\"191\"/></p>\n<p style=\"text-align: center;\">Anopia <strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Optic Chiasma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bilateral <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">Nasal</span> Fibers</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"202\" src=\"https://image.prepladder.com/content/vco4NE3RLCRoGzjsnzAd1745408898.png\" width=\"201\"/></p>\n<p style=\"text-align: center;\"><strong>Bitemporal Hemianopia</strong></p>\n<p style=\"text-align: center;\"><strong>(Heteronymous Hemianopia)</strong> <strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Optic Tract/ <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> <span class=\"customMeta\" data-dictid=\"00b4dbe9e4169277718881a95f7864\">Geniculate</span> Body (LGB)/ <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">Optic</span> Radiation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ipsilateral <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">Temporal</span> Fibers + <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">Contralateral</span> <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">Nasal</span> Fibers</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"208\" src=\"https://image.prepladder.com/content/6wkip0hL9kZEp4T5x6o11745408903.png\" width=\"203\"/></p>\n<p style=\"text-align: center;\">Homonymous Hemianopia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Visual <span class=\"customMeta\" data-dictid=\"cab8787ce916927771852a7e72f34d\">Cortex</span> without the involvement of tip</strong></p>\n<p><strong>(Posterior Cerebral Artery)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ipsilateral <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">Temporal</span> Fibers + <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">Contralateral</span> <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">Nasal</span> Fibers except <span class=\"customMeta\" data-dictid=\"ebad8eb48c1692777191b5de5d04a1\">macular</span> representation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"214\" src=\"https://image.prepladder.com/content/DOUg9QEh17OdGadyL21x1745408911.png\" width=\"209\"/></p>\n<p style=\"text-align: center;\"><strong>Homonymous <span class=\"customMeta\" data-dictid=\"64341b503a1692777188b9a3b26c59\">Hemianopia</span> with <span class=\"customMeta\" data-dictid=\"ebad8eb48c1692777191b5de5d04a1\">Macular</span> Sparing</strong></p>\n<p style=\"text-align: center;\"><strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tip of Visual Cortex</strong></p>\n<p><strong>(Middle Cerebral Artery)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Macular Representation of <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">Ipsilateral</span> <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">Temporal</span> and <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">Contralateral</span> <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">Nasal</span> Fibers.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"211\" src=\"https://image.prepladder.com/content/hLPwF3BjCqyOuyQ8xrKN1745408918.png\" width=\"206\"/></p>\n<p style=\"text-align: center;\">Macular <span class=\"customMeta\" data-dictid=\"0600a6b52316927771899e12e7ec86\">Homonymous</span> Hemianopia</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely diagnosis for a 2-month-old infant who was brought in by their mother due to complaints of light sensitivity, difficulty opening the eyes, and excessive tearing?", "options": [{"label": "A", "text": "Ophthalmia neonatorum", "correct": false}, {"label": "B", "text": "Congenital glaucoma", "correct": true}, {"label": "C", "text": "Congenital Dacryocele", "correct": false}, {"label": "D", "text": "Congenital Cataract", "correct": false}], "correct_answer": "B. Congenital glaucoma", "question_images": ["https://image.prepladder.com/content/6vwA1TNjbJg1y1OxA71F1745409183.png"], "explanation_images": ["https://image.prepladder.com/notes/zyNteOFstZweQoV8tEgZ1746440883.png", "https://image.prepladder.com/notes/jp7ogj2EYD6MoN5dMLpE1746440929.png"], "explanation": "<p>Correct Answer B - &lt;span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\"&gt;Congenital&lt;/span&gt; glaucoma:</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ol>\n<li><strong>Newborn glaucoma/ True <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> glaucoma:</strong> Elevated <span class=\"customMeta\" data-dictid=\"1ba26fe8171692777190a867ec47c7\">intraocular</span> pressure is present during <span class=\"customMeta\" data-dictid=\"1d5d2712dc169277719050154d38a1\">intrauterine</span> life, resulting in <span class=\"customMeta\" data-dictid=\"7b1f175723169277719459db16938e\">ocular</span> <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">enlargement</span> at birth. Typically presents within the first month of life.</li>\n<li><strong>Infantile:</strong> ≤ 3 yrs of age</li>\n<li><strong>Juvenile:</strong> &gt; 3 yrs of age</li>\n</ol>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Trabeculodysgenesis</li>\n<li>Angle Recess Absence</li>\n<li>Iris Insertion Types:\n\t\t\t\t<ul>\n<li>Flat Insertion: Reveals the <span class=\"customMeta\" data-dictid=\"1be9f55b2d1692777184b9d813b17e\">ciliary</span> body and scleral spur.</li>\n<li>Concave Insertion: Obscures the <span class=\"customMeta\" data-dictid=\"d523549f091692777198f5ec70ed9e\">scleral spur</span> and <span class=\"customMeta\" data-dictid=\"1be9f55b2d1692777184b9d813b17e\">ciliary</span> body.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Classic Triad:</strong> Lacrimation, photophobia, and blepharospasm; often accompanied by eye rubbing.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Congenital Glaucoma\" data-author=\"S. Senthil, S. Badakere, Jonnadula Ganesh, Rashmi Krishnamurthy, Siddharth Dikshit, N. Choudhari, C. Garudadri, A. Mandal\" data-hash=\"11918\" data-license=\"Open access\" data-source=\"https://www.semanticscholar.org/paper/Profile-of-childhood-glaucoma-at-a-tertiary-center-Senthil-Badakere/bc27a485cc916e6c96e909f8d28a97ba8737b151\" data-tags=\"May2025\" height=\"217\" src=\"https://image.prepladder.com/notes/zyNteOFstZweQoV8tEgZ1746440883.png\" width=\"556\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Corneal Signs:</strong>\n<ul>\n<li>Oedema: Early sign, may progress to permanent opacity.</li>\n<li>Enlargement: Corneal <span class=\"customMeta\" data-dictid=\"afb15e4a331692777186e495b370a1\">diameter</span> &gt;13 mm confirms enlargement; &gt;16 mm indicates poor prognosis.</li>\n</ul>\n</li>\n<li><strong>Haab’s Striae:</strong> Tears in Descemet's membrane, visible as <span class=\"customMeta\" data-dictid=\"1b8aa0db391692777194178f73c98c\">opaque</span> lines.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Haab's Striae\" data-author=\"Maxwell, Giorgina &amp; Souzeau, Emmanuelle.\" data-hash=\"11920\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Ocular-signs-of-childhood-glaucoma-A-Megalocornea-and-corectopia-B-Haab-striae_fig2_383522893\" data-tags=\"May2025\" height=\"281\" src=\"https://image.prepladder.com/notes/jp7ogj2EYD6MoN5dMLpE1746440929.png\" width=\"332\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>Additional Features:\n\t\t\t\t<ul>\n<li><strong>Deep Anterior Chamber:</strong> Indicates elevated IOP.</li>\n<li>Optic Disc Changes: Variable <span class=\"customMeta\" data-dictid=\"4d57ccd00f1692777185c371df0426\">cupping</span> and atrophy.</li>\n<li><strong>Raised IOP:</strong> Elevated but not acute.</li>\n<li><strong>Axial Myopia:</strong> Due to increased <span class=\"customMeta\" data-dictid=\"01591f7f591692777182ef8aa2360c\">axial</span> length.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Direct Goniotomy followed by Trabeculotomy</strong> - preferred management for <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">Congenital</span> Glaucoma</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient on Digoxin, Potassium chloride, Clarithromycin, Atenolol and Triamterene developed atrial fibrillation with controlled ventricular rate. Investigations showed elevated Digoxin levels. Which of the following drugs is responsible for the rise in serum Digoxin?", "options": [{"label": "A", "text": "Potassium Chloride", "correct": false}, {"label": "B", "text": "Clarithromycin", "correct": true}, {"label": "C", "text": "Atenolol", "correct": false}, {"label": "D", "text": "Rifampicin", "correct": false}], "correct_answer": "B. Clarithromycin", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:710px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>P-glycoprotein Inducer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>P-glycoprotein Inhibitor</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Activity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increases the activity of Pgp</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreases the activity of Pgp</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Drugs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Rifampicin</li>\n<li>Phenobarbitone.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mnemonic: QVACKER</p>\n<ul>\n<li>Quinidine</li>\n<li><strong>Verapamil</strong></li>\n<li>Amiodarone</li>\n<li>Clarithromycin</li>\n<li>Ketoconazole</li>\n<li>Erythromycin</li>\n<li>Ritonavir</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Combined with Substrate</strong></p>\n<p><strong>of p-glycoprotein</strong></p>\n<p><strong>(Digoxin)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increases the activity of P-gp.</p>\n<ul>\n<li>Increased <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> excretion.</li>\n<li>Digoxin is excreted.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reduces the activity of P-gp.</p>\n<ul>\n<li>Reduced <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> excretion.</li>\n<li>Increased <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> concentration of the drug.</li>\n<li>Toxicity of digoxin: Arrhythmias.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old woman on oral contraceptives for the past 6 months presents with 6 weeks of amenorrhea. What would be the best method of assessing the gestational age of this patient? LMP- Last Menstrual Period USG- Ultrasonography", "options": [{"label": "A", "text": "Crown-rump length by USG", "correct": true}, {"label": "B", "text": "Adding 280 days to the LMP", "correct": false}, {"label": "C", "text": "Fundus examination", "correct": false}, {"label": "D", "text": "Adding 256 days to the LMP", "correct": false}], "correct_answer": "A. Crown-rump length by USG", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gestational Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Parameter </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Threshold Value to Redate</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&lt;9 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CRL</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;5 days</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>9 to &lt;14 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>CRL</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;7 days</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>14 to &lt;16 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>BPD, HC, AC, FL</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;7 days</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>16 to &lt;22 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>BPD, HC, AC, FL</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;10 days</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>22 to &lt;28 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>BPD, HC, AC, FL</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;14 days</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>≥ 28 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>BPD, HC, AC, FL</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>&gt;21 days</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the mechanism of action of Methotrexate in Osteosarcoma?", "options": [{"label": "A", "text": "Analogue of UMP", "correct": false}, {"label": "B", "text": "Competitive inhibitor of DHFR", "correct": true}, {"label": "C", "text": "Blocks Purine synthesis", "correct": false}, {"label": "D", "text": "Blocks Pyrimidine synthesis", "correct": false}], "correct_answer": "B. Competitive inhibitor of DHFR", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/Q4IuhGRbm5wUBNnrzvG51746441435.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The person in the image is at the risk of developing?", "options": [{"label": "A", "text": "Exposure keratopathy", "correct": true}, {"label": "B", "text": "Restricted eye movements", "correct": false}, {"label": "C", "text": "Diplopia", "correct": false}, {"label": "D", "text": "Amblyopia", "correct": false}], "correct_answer": "A. Exposure keratopathy", "question_images": ["https://image.prepladder.com/content/PYUm5SGteaqc2WWMdeNo1745409438.png"], "explanation_images": ["https://image.prepladder.com/content/SyEzJBiyRjcBOKCwXQIz1745409519.png", "https://image.prepladder.com/content/zIXIaOc5I2eM4HBQR2uH1745409524.png", "https://image.prepladder.com/content/c7Vkc256cJgON2iVmK7Z1745409529.png", "https://image.prepladder.com/content/M6weBg1wvFFBjCVKJPtw1745409535.png", "https://image.prepladder.com/content/XZSgRTMzaBfJqNkK38gy1745409540.png"], "explanation": "<p>Correct Answer A - Exposure keratopathy</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Iris Coloboma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Pear-shaped <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> extending from the <span class=\"customMeta\" data-dictid=\"e419fd4e241692777196d038d1b71a\">pupil</span> but not always reaching the <span class=\"customMeta\" data-dictid=\"1be9f55b2d1692777184b9d813b17e\">ciliary</span> body. It may occur alone or be associated with colobomata of the lens, choroid, or retina.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Jmarchn\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Coloboma#/media/File:Coloboma_of_the_iris.JPG\" data-tags=\"\" height=\"118\" src=\"https://image.prepladder.com/content/SyEzJBiyRjcBOKCwXQIz1745409519.png\" width=\"200\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Coloboma of lens</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Notch-shaped <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> typically found along the <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> lens margin due to incomplete development of the <span class=\"customMeta\" data-dictid=\"f905752e7d169277719903de8a1ca9\">suspensory</span> ligament.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Doğan, Mustafa &amp; Polat, Onur &amp; Akcı, Onder &amp; Yavas, Güliz. \" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Lens-coloboma-right-eye-left-left-eye-right_fig2_284547899\" data-tags=\"\" height=\"155\" src=\"https://image.prepladder.com/content/zIXIaOc5I2eM4HBQR2uH1745409524.png\" width=\"200\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fundus Coloboma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Oval or comet-shaped <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> with a rounded <span class=\"customMeta\" data-dictid=\"2d7ea2751316927771816ceb31afee\">apex</span> toward the <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> disc, often with an irregularly depressed surface.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Mary Varghese ,JoelA Kavalakatt ,Shweta Pandey ,JerryJ Kolath\" data-hash=\"\" data-license=\"CC BY NC SA 4.0\" data-source=\"https://www.researchgate.net/figure/Fundus-picture-of-right-the-eye-showing-coloboma-inferior-to-optic-disc_fig1_294109531\" data-tags=\"\" height=\"194\" src=\"https://image.prepladder.com/content/c7Vkc256cJgON2iVmK7Z1745409529.png\" width=\"200\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Coloboma of <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">Optic</span> Disc</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>It appears as an <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> <span class=\"customMeta\" data-dictid=\"0539eefe3f169277718547881d187d\">crescent</span> at the lower edge of the disc due to incomplete <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> of the embryonic fissure.</li>\n<li>Found in Hypermetropic and Astigmatic eyes.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Bassi, Shikha &amp; George, Ronnie &amp; Sen, Swarnali &amp; Asokan, Rashima &amp; Vijaya, Lingam.\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/Optic-disc-coloboma-on-19-April-2018-by-guest-Protected-by-copyright_fig2_323954052\" data-tags=\"\" height=\"150\" src=\"https://image.prepladder.com/content/M6weBg1wvFFBjCVKJPtw1745409535.png\" width=\"200\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Coloboma of Lid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Notch or gap in the <span class=\"customMeta\" data-dictid=\"819ddea9e51692777187cdff06b437\">eyelid</span> edge, most commonly on the upper lid, often associated with <span class=\"customMeta\" data-dictid=\"6e53fc929616927771900fbab3617f\">iris</span> <span class=\"customMeta\" data-dictid=\"39ab9251f916927771844eb7894e10\">coloboma</span> or <span class=\"customMeta\" data-dictid=\"9088e1c7f616927771802e7f6d2541\">accessory</span> auricles.</li>\n<li>The corneal surface cannot stay lubricated and hence can lead to exposure keratopathy.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Kator Chaha ,Sunday O Ajike\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"CC BY 4.0\" data-tags=\"\" height=\"179\" src=\"https://image.prepladder.com/content/XZSgRTMzaBfJqNkK38gy1745409540.png\" width=\"200\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following drugs should not be consumed by a patient with bacterial vaginosis and trichomoniasis currently on metronidazole?", "options": [{"label": "A", "text": "Grapefruit juice", "correct": false}, {"label": "B", "text": "Alcohol", "correct": true}, {"label": "C", "text": "Benzodiazepine", "correct": false}, {"label": "D", "text": "MAOI / SSRI", "correct": false}], "correct_answer": "B. Alcohol", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:742px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Metronidazole</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>MOA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Prodrug is converted to active <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> through <span class=\"customMeta\" data-dictid=\"bb349efe571692777193cd0d07baeb\">nitro</span> group reduction inside the bacteria → formation of <span class=\"customMeta\" data-dictid=\"5536b77611169277719356d32e638a\">nitric</span> <span class=\"customMeta\" data-dictid=\"e08c004e8f1692777194c9d37e17ad\">oxide</span> free radicals → causes DNA damage → inhibits replication.</li>\n<li>Inhibits PFOR <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> (pyruvate <span class=\"customMeta\" data-dictid=\"91d0e4c6fa16927772025f96b44b27\">ferritin</span> oxido reductase) in <span class=\"customMeta\" data-dictid=\"b87627c189169277719689567ed39e\">protozoa</span> → DNA damage.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Uses </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Giardiasis (in HIV-positive patients)</li>\n<li>Entamoeba histolytica → <span class=\"customMeta\" data-dictid=\"1b0f3628231692777181232735c06b\">Amebic dysentery</span> &amp; amebic liver abscess</li>\n<li>Trichomonas vaginalis</li>\n<li>Bacterial Vaginosis</li>\n<li>Dracunculus (guinea worm)</li>\n<li>Gardenella / bacterial vaginosis</li>\n<li>Empiric <span class=\"customMeta\" data-dictid=\"b02812a466169277719090c2d27868\">intra-abdominal</span> and soft tissue <span class=\"customMeta\" data-dictid=\"4880fc99551692777181e25a64560f\">anaerobic</span> infections</li>\n<li>H. pylori <span class=\"customMeta\" data-dictid=\"7861e10657169277718815c2f42a75\">gastritis</span> (combined with <span class=\"customMeta\" data-dictid=\"9c823198d61692777196bc71097d6d\">proton</span> pump inhibitor)</li>\n<li>Prophylaxis for <span class=\"customMeta\" data-dictid=\"f04bf2125316927771847bfe139191\">colorectal</span> surgery</li>\n<li>Fulminant C.difficile infection (IV <span class=\"customMeta\" data-dictid=\"452c41e7811692777192cd0d89fdc7\">metronidazole</span> + oral vancomycin)</li>\n<li>Mild to moderate Crohn's disease</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Adverse effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Metallic taste, intensely bitter</li>\n<li>Headache, nausea, <span class=\"customMeta\" data-dictid=\"e3afd7f63b1692777186b9a6e7824d\">dry mouth</span> (most common)</li>\n<li>Vomiting, diarrhoea, and <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> distress</li>\n<li>Dysuria, cystitis, and a sense of <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> pressure</li>\n<li>Dizziness, vertigo,</li>\n<li>Neurotoxicity: <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">Peripheral</span> neuropathy, numbness, paresthesias, ataxia</li>\n<li>Brown color urine</li>\n<li>Urticaria, flushing, and <span class=\"customMeta\" data-dictid=\"c238cff71916927771965fb88e6cc4\">pruritus</span> ( rare cause of Stevens-Johnson syndrome)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Drug Interaction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Inhibitor of CYP enzymes</li>\n<li>Disulfiram-like effect: <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> distress, vomiting, flushing, headache or <span class=\"customMeta\" data-dictid=\"1cb2d1482916927771964c2890313e\">psychosis</span> with <span class=\"customMeta\" data-dictid=\"0751b802aa169277718100e38a1276\">alcoholic</span> beverages during or within 3 days of therapy.</li>\n<li>Precipitate <span class=\"customMeta\" data-dictid=\"42659effea16927771919c6224e529\">lithium</span> toxicity</li>\n<li>Prothrombin time prolongation with <span class=\"customMeta\" data-dictid=\"38d84b192c16927772023d96107e4c\">warfarin</span> (anticoagulant).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Contraindications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>CNS diseases</li>\n<li>Severe <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> disease</li>\n<li>First <span class=\"customMeta\" data-dictid=\"2c20f0f1dd169277720029d29458d5\">trimester</span> of pregnancy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following interleukin (IL) is inhibited by Tocilizumab?", "options": [{"label": "A", "text": "IL-2", "correct": false}, {"label": "B", "text": "IL-5", "correct": false}, {"label": "C", "text": "IL-4", "correct": false}, {"label": "D", "text": "IL-6", "correct": true}], "correct_answer": "D. IL-6", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old woman with a history of hypertension presented to the emergency room with loss of consciousness, chest pain, and diaphoresis. On examination, she was grossly unstable, and the bilateral pulses were unequal. ECG showed nonspecific ST-T changes. What is the next best investigation?", "options": [{"label": "A", "text": "MRI", "correct": false}, {"label": "B", "text": "Transoesophageal echocardiography", "correct": true}, {"label": "C", "text": "Cardiac enzymes", "correct": false}, {"label": "D", "text": "X-ray", "correct": false}], "correct_answer": "B. Transoesophageal echocardiography", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old chronic hypertensive woman comes to the OPD for preconception counselling. Which of the following antihypertensives should be discontinued in this patient?", "options": [{"label": "A", "text": "Labetalol", "correct": false}, {"label": "B", "text": "Calcium channel blocker", "correct": false}, {"label": "C", "text": "Angiotensin-converting enzyme inhibitor", "correct": true}, {"label": "D", "text": "Alpha - methyldopa", "correct": false}], "correct_answer": "C. Angiotensin-converting enzyme inhibitor", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Antihypertensives in pregnancy </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>To be used </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>To be avoided </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Labetalol (α + β <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antagonist)</li>\n<li>Nifedipine (Calcium channel <span class=\"customMeta\" data-dictid=\"adecdf9cb2169277718363b8a0e491\">blocker</span> *)</li>\n<li>α - Methyldopa</li>\n<li>Hydralazine</li>\n<li>Thiazides can be used in chronic <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> in pregnant women</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>ACEi and ARB - teratogenic</li>\n<li>Diuretic - reduces <span class=\"customMeta\" data-dictid=\"091c4fd1e61692777201ec50806bc4\">uteroplacental</span> perfusion</li>\n<li>Non-selective beta-blocker</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>* CCB can be useful in preeclampsia, but they must be stopped before labour as they can weaken <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> contractions</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A pregnant woman was prescribed indomethacin. Which of the following effects will the drug have on the fetus?", "options": [{"label": "A", "text": "Premature closure of ductus arteriosus", "correct": true}, {"label": "B", "text": "Keeps ductus arteriosus patent", "correct": false}, {"label": "C", "text": "Closure of fossa ovalis", "correct": false}, {"label": "D", "text": "Premature closure of ductus venosus", "correct": false}], "correct_answer": "A. Premature closure of ductus arteriosus", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following drugs can be used to treat open-angle glaucoma in a patient with bronchial asthma?", "options": [{"label": "A", "text": "Latanoprost", "correct": true}, {"label": "B", "text": "Timolol", "correct": false}, {"label": "C", "text": "Gemeprost", "correct": false}, {"label": "D", "text": "Mannitol infusion", "correct": false}], "correct_answer": "A. Latanoprost", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/FqbXqhbkITkqe4A9qYtp1746442697.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Latanoprost</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>MOA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Alters <span class=\"customMeta\" data-dictid=\"1be9f55b2d1692777184b9d813b17e\">ciliary</span> muscle tension - improves <span class=\"customMeta\" data-dictid=\"0f0067663b16927771818fe253b3b9\">aqueous</span> humour outflow</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Advantages </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>High efficacy</li>\n<li>Once daily application only</li>\n<li>No <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> side effects</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Disadvantages </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Expensive</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Adverse effects </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Blurring of vision</li>\n<li>Iris pigmentation</li>\n<li>Thickening and darkening of eyelashes</li>\n<li>Macular <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> (in aphakic patients )</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Drugs used in the management of <span class=\"customMeta\" data-dictid=\"61e49875801692777188ad5edea804\">glaucoma</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Drugs increasing trabecular outflow </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Miotics</li>\n<li>Dipivefrine, Epinephrine</li>\n<li>Bimatoprost</li>\n<li>Netarsidil</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Drugs increasing uveoscleral outflow </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>PGF2α <span class=\"customMeta\" data-dictid=\"22e0051a181692777181872183edb2\">analogue</span> - <strong>Latanoprost</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Drugs decreasing <span class=\"customMeta\" data-dictid=\"0f0067663b16927771818fe253b3b9\">aqueous</span> humour production </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Carbonic <span class=\"customMeta\" data-dictid=\"0a72e82d651692777181ef79d77e61\">anhydrase</span> inhibitors - <strong>Acetazolamide </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hyperosmotic agents </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Mannitol</li>\n<li>Urea</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In iron deficiency anaemia, all of the following are increased except:", "options": [{"label": "A", "text": "Transferrin saturation", "correct": true}, {"label": "B", "text": "RBC protoporphyrin", "correct": false}, {"label": "C", "text": "Total iron binding capacity", "correct": false}, {"label": "D", "text": "Ferritin soluble receptors", "correct": false}], "correct_answer": "A. Transferrin saturation", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:609px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Iron Study</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Interpretation in Iron <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">Deficiency</span> Anemia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Serum Ferritin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low (&lt; 30 ng/mL)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Serum Iron (Fe)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Serum <span class=\"customMeta\" data-dictid=\"d404d819f41692777200b686a0759e\">transferrin</span> <span class=\"customMeta\" data-dictid=\"e4696a0f8d169277719865588e55c7\">saturation</span> </strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Total Iron Binding Capacity (TIBC) (Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased: TIBC reflects the increased capacity of <span class=\"customMeta\" data-dictid=\"d404d819f41692777200b686a0759e\">transferrin</span> to bind iron in response to low iron stores.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Red Cell Distribution <span class=\"customMeta\" data-dictid=\"1b0d31fe811692777202644090ba60\">Width</span> (RDW)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ferritin <span class=\"customMeta\" data-dictid=\"845fedd06d16927771989597afa034\">soluble</span> receptors (sTfR)(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>RBC <span class=\"customMeta\" data-dictid=\"510ec2d8ea1692777196c492eae686\">protoporphyrin</span> (Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Bone Marrow Aspiration and Iron Staining</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Confirmatory test for Iron <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> anaemia.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "As a medical practitioner in India, how will you prescribe Alprazolam to a patient?", "options": [{"label": "A", "text": "1mg OD HS for 7 days", "correct": false}, {"label": "B", "text": "0.5 mg OD HS for 7 days", "correct": false}, {"label": "C", "text": "0.5 mg BD for 7 days", "correct": false}, {"label": "D", "text": "0.5 mg once daily before bedtime for 7 days", "correct": true}], "correct_answer": "D. 0.5 mg once daily before bedtime for 7 days", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A contact lens user presents with the following clinical picture. He has had watering, redness, and foreign body sensation in the eye for the past 2 months. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Follicular conjunctivitis", "correct": false}, {"label": "B", "text": "Spring catarrh", "correct": false}, {"label": "C", "text": "Giant papillary conjunctivitis", "correct": true}, {"label": "D", "text": "Trachoma", "correct": false}], "correct_answer": "C. Giant papillary conjunctivitis", "question_images": ["https://image.prepladder.com/notes/p0WMGohHylCS9mBDLea11746441774.png"], "explanation_images": ["https://image.prepladder.com/content/NYz2JCcKlx9f4sqKHYTJ1745410026.png", "https://image.prepladder.com/content/62AHBz0SIU2ewYtzOG6q1745410035.png", "https://image.prepladder.com/content/CrUa6zUrkQ78xARZfKGp1745410044.png", "https://image.prepladder.com/content/qdvr6m4OzvWeTA6QtZZX1745410058.png"], "explanation": "<p>Correct Answer C - Giant &lt;span class=\"customMeta\" data-dictid=\"62b9af909d1692777194cd004f10f4\"&gt;papillary&lt;/span&gt; conjunctivitis</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Specific allergic <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> affecting the superior <span class=\"customMeta\" data-dictid=\"b07a8f84ed1692777200d49cca6177\">tarsal</span> conjunctiva.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Etiology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Soft <span class=\"customMeta\" data-dictid=\"db283047011692777189a869dbce07\">hydrophilic</span> <strong>contact lenses</strong></li>\n<li>Protruding <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> ends</li>\n<li>Ocular prostheses</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Underlying Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hypersensitivity reactions <strong>(types I and IV)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Symptoms </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Itching/ Watering</li>\n<li>Foreign body sensation</li>\n<li>Occasionally blurred vision</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Signs </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Conjunctival <span class=\"customMeta\" data-dictid=\"2dd9736fdf16927771849f5a925f7d\">congestion</span> predominantly in the upper palpebral region</li>\n<li>Large polygonal <span class=\"customMeta\" data-dictid=\"c948d4dca7169277719474a468ff5e\">papillae</span> on superior <span class=\"customMeta\" data-dictid=\"b07a8f84ed1692777200d49cca6177\">tarsal</span> conjunctiva</li>\n<li>Macropapillae (0.3-1.0 mm) and giant <span class=\"customMeta\" data-dictid=\"c948d4dca7169277719474a468ff5e\">papillae</span> (1-2 mm)</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Ono, Santa &amp; Abelson, Mark.\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/Four-types-of-ocular-allergy_fig1_8092872\" data-tags=\"\" height=\"320\" src=\"https://image.prepladder.com/content/NYz2JCcKlx9f4sqKHYTJ1745410026.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Discontinue soft contact lenses, remove offending sutures, clean and polish <span class=\"customMeta\" data-dictid=\"7b1f175723169277719459db16938e\">ocular</span> prosthesis; replace with <span class=\"customMeta\" data-dictid=\"ed1050ab241692777183d28df9ecad\">biocompatible</span> material (e.g., Biocoat).</li>\n<li>Ancillary therapy: Mast cell stabilizers (e.g., lodoxamide, <span class=\"customMeta\" data-dictid=\"d3f7cd4f92169277718588c69a0f10\">cromolyn</span> sodium, olopatadine) along with artificial tears, <span class=\"customMeta\" data-dictid=\"4b296ae29b16927771815960a008db\">antihistaminic</span> drops, and decongestants.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the term used to describe the occurrence when a therapist experiences a combination of conscious and unconscious emotions towards their patient during psychotherapy?", "options": [{"label": "A", "text": "Countertransference", "correct": true}, {"label": "B", "text": "Transference", "correct": false}, {"label": "C", "text": "Dissociation", "correct": false}, {"label": "D", "text": "Preoccupation", "correct": false}], "correct_answer": "A. Countertransference", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Transference</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Countertransference</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Feelings of a <strong>patient towards the therapist</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Feelings of a <strong>therapist towards a patient</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">It can be <strong>positive or negative </strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Both are predominantly unconscious.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Interferes with the treatment</strong> of the patient</p>\n<p style=\"text-align: center;\">(as there could be exaggerated/diminished reactions due to this)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient who was recently started on an antihypertensive presented with the following presentation, as shown in the image below. Which of the following antihypertensive medications was most likely prescribed to him?", "options": [{"label": "A", "text": "Lisinopril", "correct": true}, {"label": "B", "text": "Nifedipine", "correct": false}, {"label": "C", "text": "Atenolol", "correct": false}, {"label": "D", "text": "Clonidine", "correct": false}], "correct_answer": "A. Lisinopril", "question_images": ["https://image.prepladder.com/notes/MTwUFZagFZb8Qld71PTP1746442804.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:659px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Adverse effects of <span class=\"customMeta\" data-dictid=\"881411ec321692777181ca707f2515\">angiotensin-converting enzyme</span> inhibitors</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hypotension</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decrease in blood pressure, especially upon <span class=\"customMeta\" data-dictid=\"a4f93a26c11692777190f1659fa7c9\">initiation</span> of therapy or with <strong>dosage increases.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hyperkalemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> levels due to<strong> <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"210102fdef1692777181bab45bdfe3\">aldosterone</span> secretion.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cough</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Persistent dry cough, possibly due to <span class=\"customMeta\" data-dictid=\"3c5739595d16927771839e61a5855c\">bradykinin</span> buildup in the lungs.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Angioedema</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Due to<strong> increased <span class=\"customMeta\" data-dictid=\"3c5739595d16927771839e61a5855c\">bradykinin</span> levels,</strong> <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> of deeper layers of skin, particularly around the eyes and lips, can be life-threatening.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Rashes/Urticaria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Skin reactions like rashes or <span class=\"customMeta\" data-dictid=\"14ccc7cf1c1692777189d4fb9d1fb5\">hives</span> occur in a small percentage of users.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dysgeusia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Reversible</strong> taste changes are <strong>more common with captopril.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Rare Effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Granulocytopenia</strong> (low white blood cells) and <span class=\"customMeta\" data-dictid=\"1f58deccf71692777196e64781a01a\">proteinuria</span> (excess protein in urine) are more concerning in patients with <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Acute <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> Failure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Possible in patients with <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">stenosis</span> due to decreased <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> filtration.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fetal Effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>ACE inhibitors are <strong>contraindicated during pregnancy</strong> due to potential harm to the fetus, including <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> damage due to <span class=\"customMeta\" data-dictid=\"f03ca2d2a716927771901227bc175a\">inhibition</span> of the <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> renin-angiotensin system.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A woman presents with numbness of her fingertips. On examination, her face is tightened. The antinuclear antibody(ANA) is found to be positive and immunofluorescence shows the nucleolar pattern. What is the likely diagnosis?", "options": [{"label": "A", "text": "Systemic sclerosis", "correct": true}, {"label": "B", "text": "Sjogren’s syndrome", "correct": false}, {"label": "C", "text": "Systemic lupus erythematosus", "correct": false}, {"label": "D", "text": "Rheumatoid arthritis", "correct": false}], "correct_answer": "A. Systemic sclerosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/77GucPj9qUqDqihvFilI1746442122.png", "https://image.prepladder.com/notes/74mADEIJKq1RYm7wIre51746442146.png", "https://image.prepladder.com/notes/Z06KwHpWl74LLDjsgvWx1746442171.png", "https://image.prepladder.com/notes/AQq5QLvSi1q7x2NkxScL1746442200.png", "https://image.prepladder.com/content/wRqpzGg4A28Vupt8mnYX1745410216.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is a poor prognostic marker of multiple myeloma?", "options": [{"label": "A", "text": "β-2 microglobulin", "correct": true}, {"label": "B", "text": "Calcium levels", "correct": false}, {"label": "C", "text": "Serum creatinine", "correct": false}, {"label": "D", "text": "Protein levels", "correct": false}], "correct_answer": "A. β-2 microglobulin", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<h3><strong>Diagnostic Criteria for Multiple Myeloma</strong><strong> </strong></h3>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Presence of Clonal <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> cells in <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> or presence of <span class=\"customMeta\" data-dictid=\"a3792999e71692777185880d431114\">CRAB</span> criteria (hypercalcemia, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> dysfunction, anaemia and bone lesions)</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1. Evidence of one or more indicators of <strong>end-organ damage</strong> attributed to the <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> cell disorder, specifically: <strong>(CRAB)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hypercalcemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Serum <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> &gt;0.25 mmol/L above the upper limit of normal or &gt;2.75 mmol/L<strong> (&gt;11 mg/dL)</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Renal Insufficiency</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Creatinine <span class=\"customMeta\" data-dictid=\"3a3fb1b8a816927771840e6a344cc0\">clearance</span> &lt;40 mL/min or <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> &gt;177 μmol/L <strong>(&gt;2 mg/dL)</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Anemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hemoglobin &gt;20 g/L below the lower limit of normal or haemoglobin <strong>&lt;100 g/L or &lt;10g/100ml</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Bone Lesions</strong>:</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>One or more <strong>osteolytic lesions were </strong>identified on skeletal radiography, CT, or PET-CT.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>2. Biomarkers of Malignancy</strong> <strong>(any one of the following)</strong>:</p>\n<ul>\n<li>Clonal <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> cells ≥60%.</li>\n<li>Involved: uninvolved serum-free <span class=\"customMeta\" data-dictid=\"578fe8d7dd16927771913c847ed254\">light chain</span> ratio ≥100.</li>\n<li>1 <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> on <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> studies.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Poor <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">Prognosis</span> markers:</strong> ↑ β2 microglobulin.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A middle-aged man with chronic renal failure on dialysis presents with sudden collapse to the casualty with laboured breathing. ECG shows tall, tented T waves. What is the most likely acid-base imbalance that can be seen in this patient?", "options": [{"label": "A", "text": "pH-7.14, pCO2-20 mmHg, HCO3- 5 mEq/L", "correct": true}, {"label": "B", "text": "pH-7.14, pCO2-20 mmHg, HCO3- 34 mEq/L", "correct": false}, {"label": "C", "text": "pH-7.54, pCO2- 34 mmHg, HCO3- 27 mEq/L", "correct": false}, {"label": "D", "text": "pH-7.4, pCO2- 40 mmHg, HCO3- 27 mEq/L", "correct": false}], "correct_answer": "A. pH-7.14, pCO2-20 mmHg, HCO3- 5 mEq/L", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Metabolic <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">acidosis</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Primary <strong>decrease in HCO<sub>3</sub>⁻</strong> or increase in H⁺ ions</li>\n<li>Characterized by <strong>↓ pH and ↓ HCO<sub>3</sub>⁻</strong></li>\n<li>Compensatory mechanism: ↓ PaCO<sub>2</sub> through <span class=\"customMeta\" data-dictid=\"e07ff4a5ce1692777189b9e95326f3\">hyperventilation</span> (Kussmaul breathing)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>High <span class=\"customMeta\" data-dictid=\"53e82fca731692777181e629a02799\">anion</span> gap (AG &gt; 12 mEq/L)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Normal <span class=\"customMeta\" data-dictid=\"53e82fca731692777181e629a02799\">anion</span> gap (AG 6-12 mEq/L)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Causes </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>(Mnemonic: MUDPILES)</strong></p>\n<ul>\n<li><strong>M</strong>: Methanol</li>\n<li><strong>U</strong>: <strong>Uremia (Renal failure) </strong></li>\n<li><strong>D</strong>: <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">Diabetic</span> <span class=\"customMeta\" data-dictid=\"27b295ed331692777190e5e04eaa18\">ketoacidosis</span> (DKA)<strong> </strong></li>\n<li><strong>P</strong>: Paraldehyde, Phenformin, <span class=\"customMeta\" data-dictid=\"e2c0074e9c1692777196b2028a4274\">Propylene</span> glycol</li>\n<li><strong>I</strong>: Iron tablets, Isoniazid</li>\n<li><strong>L</strong>: <span class=\"customMeta\" data-dictid=\"b82539c9ae1692777191a3f7ddd7bb\">Lactic</span> acidosis</li>\n<li><strong>E</strong>: <span class=\"customMeta\" data-dictid=\"8e2fdef08316927771877389af9cc7\">Ethylene</span> glycol</li>\n<li><strong>S</strong>: Salicylates (late phase)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>(Mnemonic: HARD UP)</strong></p>\n<ul>\n<li><strong>H</strong>: <span class=\"customMeta\" data-dictid=\"9f3f3ebd8c16927771891dc68e6fcf\">Hyperalimentation</span> (TPN)</li>\n<li><strong>A</strong>: Acetazolamide</li>\n<li><strong>R</strong>: <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">Tubular</span> Acidosis</li>\n<li><strong>D</strong>: Diarrhea</li>\n<li><strong>U</strong>: Ureteral diversion</li>\n<li><strong>P</strong>: Pancreatic fistula</li>\n<li>GIT fistulas</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>General Features:</strong></p>\n<ul>\n<li>Lethargy</li>\n<li>Confusion</li>\n<li>Fatigue</li>\n<li>Nausea/vomiting</li>\n<li><strong>Deep, rapid breathing (Kussmaul)</strong></li>\n</ul>\n<p><strong>Specific Features:</strong></p>\n<ul>\n<li>DKA: Fruity breath, polyuria, polydipsia</li>\n<li>Uremia: Itching, volume overload</li>\n<li>Lactic acidosis: Shock, hypotension</li>\n<li>Toxic ingestion: Visual disturbances (methanol), <span class=\"customMeta\" data-dictid=\"28ddbfbaa51692777194aa6875fac4\">oxalate</span> crystals (ethylene glycol)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient stopped alcohol consumption for 3 days and presented with irritability, disorientation, paranoid delusions, agitation, visual hallucinations, and altered sensorium. What is the likely diagnosis in this case?", "options": [{"label": "A", "text": "Delirium tremens", "correct": true}, {"label": "B", "text": "Wernicke’s encephalopathy", "correct": false}, {"label": "C", "text": "Korsakoff psychosis", "correct": false}, {"label": "D", "text": "Alcohol-induced psychosis", "correct": false}], "correct_answer": "A. Delirium tremens", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:696px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Alcohol Withdrawal</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Onset after last drink</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mild withdrawal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Mild anxiety</li>\n<li>Tremulousness</li>\n<li>Nausea</li>\n<li>Headache</li>\n<li>Palpitations</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6-8 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Moderate (Alcoholic hallucinosis) </strong><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Visual, auditory, or <span class=\"customMeta\" data-dictid=\"ff110f2cb71692777200a3483aa670\">tactile</span> hallucinations</li>\n<li>Intact orientation</li>\n<li>Normal vital signs</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>8- 12 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Severe (Withdrawal seizures)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Generalized <span class=\"customMeta\" data-dictid=\"a4156d43e216927772008460f9b582\">tonic-clonic</span> seizures</li>\n<li>Usually brief and self-limited</li>\n<li>Also known as rum fits</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>12-24 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Life-threatening (Delirium tremens)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Severe agitation</li>\n<li>Confusion and disorientation</li>\n<li>Hallucinations (often visual)</li>\n<li>Autonomic <span class=\"customMeta\" data-dictid=\"2e780c7fd416927771895c61217c12\">hyperactivity</span> (tachycardia, hypertension, fever)</li>\n<li>Profound sweating</li>\n<li>Tremors</li>\n<li>Insomnia</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Within 72 hours</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An 18-year-old male presented to the outpatient department with gum bleeding and fever for the past 2 months. The general examination showed pallor, and the systemic examination was unremarkable. Laboratory examination revealed a Hb level of 3 g/dl, a TLC of 1500/microL, and a platelet count of 15,000/microL. A peripheral smear shows macrocytes, and the reticulocyte count is 0.5%. A bone marrow examination revealed fatty streaks and absent megakaryocytes with no immature cells. What is the likely diagnosis?", "options": [{"label": "A", "text": "Idiopathic acquired aplastic anaemia", "correct": true}, {"label": "B", "text": "Paroxysmal nocturnal hemoglobinuria", "correct": false}, {"label": "C", "text": "Myelodysplastic syndrome", "correct": false}, {"label": "D", "text": "Tuberculosis", "correct": false}], "correct_answer": "A. Idiopathic acquired aplastic anaemia", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/bYBJ0iKpgXkrSnnYzh8j1746443063.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child is presenting with palpable blanching purpura, abdominal pain, and pain in the knee joint resulting from arthritis. Urine examination showed hematuria and proteinuria. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Immune thrombocytopenic purpura", "correct": false}, {"label": "B", "text": "Dengue", "correct": false}, {"label": "C", "text": "Churg-Strauss syndrome", "correct": false}, {"label": "D", "text": "Henoch-Schonlein purpura", "correct": true}], "correct_answer": "D. Henoch-Schonlein purpura", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:637px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Henoch-Schönlein <span class=\"customMeta\" data-dictid=\"0acd34c758169277719644923511e5\">Purpura</span> (IgA vasculitis)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is a <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"fcb3e0d7911692777201ffb9695dea\">vasculitis</span> characterised by <strong>inflammation of small blood vessels</strong>, primarily affecting <strong>children,</strong> but can also occur in adults.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Etiology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Often follows upper <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infections</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Immune complex deposition of <span class=\"customMeta\" data-dictid=\"68bae589ad169277718918627baff4\">IgA</span> in small blood vessels leads to inflammation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Inflammation of small blood vessels</strong> primarily affects <strong>children</strong> but can also occur in adults.</li>\n<li>Associated with <strong>elevated <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"68bae589ad169277718918627baff4\">IgA</span> levels</strong></li>\n<li><strong>Skin</strong>: <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">Palpable</span> purpura, most prominently on the lower limbs and buttocks.</li>\n<li><strong>Musculoskeletal</strong>: <span class=\"customMeta\" data-dictid=\"7fbf2bac0e1692777182ab459be337\">Arthralgia</span> or arthritis, often <span class=\"customMeta\" data-dictid=\"a6cf2c3dc51692777200ef7fb22f69\">transient</span> and non-deforming.</li>\n<li><strong>Gastrointestinal</strong>: <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">Abdominal</span> pain, nausea, vomiting, and sometimes <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> bleeding, <span class=\"customMeta\" data-dictid=\"ecba80da7b1692777190a1ae56e0a7\">Intussusception</span> is a severe but rare complication.</li>\n<li><strong>Renal</strong>: Hematuria, proteinuria, and <span class=\"customMeta\" data-dictid=\"248111ded81692777197946454db52\">red blood cell</span> casts in urine.</li>\n<li>It can progress to <span class=\"customMeta\" data-dictid=\"68bae589ad169277718918627baff4\">IgA</span> <span class=\"customMeta\" data-dictid=\"b06dd1c5181692777193f14f3ed7d7\">nephropathy</span> in severe cases.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Supportive care</strong>: Hydration, rest, and pain management with NSAIDs for arthralgia.</li>\n<li><strong>Glucocorticoids</strong>: For severe <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> involvement, or <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> symptoms.</li>\n<li><strong>Intussusception</strong>: <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">Surgical</span> intervention if required.</li>\n<li><strong>Nephritis</strong>: Immunosuppressants (e.g., cyclophosphamide) in severe cases.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A teacher demonstrates the proper handwashing technique to her students, who then practice it both at school and at home. What type of learning does this scenario represent?", "options": [{"label": "A", "text": "Cognitive", "correct": false}, {"label": "B", "text": "Psychomotor", "correct": true}, {"label": "C", "text": "Affective", "correct": false}, {"label": "D", "text": "Affective and cognitive", "correct": false}], "correct_answer": "B. Psychomotor", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:656px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Domains of learning </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Psychomotor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Psychomotor learning involves acquiring physical skills and <span class=\"customMeta\" data-dictid=\"3820ba101416927771858fe257e119\">coordination</span> through observation, practice and repetition, and the usage of motor skill areas of the brain.</li>\n<li>It is measured based on speed, precision, distance and procedure in execution</li>\n<li>It includes imitation, manipulation, precision, <span class=\"customMeta\" data-dictid=\"29aabeda101692777182f085a61b99\">articulation</span> and naturalisation</li>\n<li>E.g., An intern learning how to insert an IV <span class=\"customMeta\" data-dictid=\"7611186da51692777183be9dcf4063\">cannula</span> by observing the staff nurse</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Affective learning </strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Includes domain of attitude and values</li>\n<li>It includes emotions, feelings, attitudes, and values</li>\n<li>It encompasses the <span class=\"customMeta\" data-dictid=\"d2a2319d681692777199792417b5e2\">subjective</span> experiences and expressions of emotions.</li>\n<li>E.g., <span class=\"customMeta\" data-dictid=\"8c3efbee661692777184685e54c75e\">communicating</span> with patients with empathy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cognitive learning </strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>It </strong>refers to <strong>mental processes</strong> related to knowledge acquisition, understanding, thinking, and problem-solving.</li>\n<li>It involves perception, memory, attention, language, and reasoning processes.</li>\n<li>E.g., Solving NEET PG entrance exam MCQs</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 54-year-old patient presents to the outpatient department with fatigue, tiredness, and cervical lymphadenopathy. The TLC and DLC were normal, with no immature cells. A lymph node biopsy showed diffuse effacement of the lymph node architecture and cells with an indented nucleus and prominent nucleolus that are atypical. CD10 and BCL2 are positive. What is the likely diagnosis?", "options": [{"label": "A", "text": "Follicular lymphoma", "correct": true}, {"label": "B", "text": "Burkitt lymphoma", "correct": false}, {"label": "C", "text": "Mycosis fungoides", "correct": false}, {"label": "D", "text": "Chronic myeloid leukaemia", "correct": false}], "correct_answer": "A. Follicular lymphoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/s6arMLYHSSX6MPb6nUeu1746443249.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Surface IHC markers </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Follicular Lymphoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>CD5 -ve, CD10+ve, CD19+ve, CD20+ve, <strong>BCL2+ve</strong>, BCL6+ve, Surface Ig+ve</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Follicular Hyperplasia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>CD3+ve, CD10+ve, CD20+ve, <strong>BCL2 -ve</strong>, BCL6+ve</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mantle Cell Lymphoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cyclin D1+ve</strong>, CD19+ve, CD20+ve, Surface Ig (usually IgM and IgD) +ve, CD5+ve, <strong>CD23 -ve</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Burkitt’s Lymphoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>IgM+ve, <strong>CD19+ve</strong>, CD20+ve, CD10+ve, BCL6+ve, <strong>BCL2 -ve</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is a formal thought disorder?", "options": [{"label": "A", "text": "Obsession", "correct": false}, {"label": "B", "text": "Derailment", "correct": true}, {"label": "C", "text": "Delusion", "correct": false}, {"label": "D", "text": "Thought insertion", "correct": false}], "correct_answer": "B. Derailment", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:611px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Abnormal thought process</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Derailment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Sudden or gradual <span class=\"customMeta\" data-dictid=\"fa328dbc09169277718631e23a772f\">deviation</span> in thought (without blocking) is often used synonymously with <span class=\"customMeta\" data-dictid=\"15228e561416927771918a5e9e15db\">loosening</span> associations.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Talking Past the Point (Vorbeireden)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The patient responds with incorrect answers related to the topic despite understanding the question.</li>\n<li>Example: Saying \"white\" for grass colour and \"green\" for snow colour.</li>\n<li>Seen in <strong>hysterical <span class=\"customMeta\" data-dictid=\"e7e9a43cb116927771965055b1999d\">pseudodementia</span> (</strong>dissociative disorder) and <strong>Ganser’s syndrome</strong> (approximate answers).</li>\n<li>It also occurs in <strong>acute schizophrenia</strong>, especially in adolescents (hebephrenia).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Loosening of Associations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Disorganised thought progression, shifting between unrelated topics, leading to <span class=\"customMeta\" data-dictid=\"a6fa56e3031692777190106e4d2339\">incoherent</span> communication.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Incoherence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Disconnected, disorganised, or incomprehensible speech.</li>\n<li><strong>Word Salad</strong>: Incoherent, incomprehensible mixture of words and phrases, often seen in advanced schizophrenia.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Word Approximation</strong></p>\n<br/>\n\t\t\t </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Using conventional words in an unconventional way (e.g., \"hand shoes\" for gloves)</li>\n<li>It is distinguished from a neologism, a newly created word with an unclear or unknown origin.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A software engineer presents to the outpatient department with easy fatiguability. He gives a history of sitting in front of the computer for 12-14 hours. He consumes a lot of junk food with very few fruits and vegetables. Hb is 9 g/dl, and MCV is 80 fl. What is the most likely cause of this patient’s anemia?", "options": [{"label": "A", "text": "Cyanocobalamin deficiency", "correct": false}, {"label": "B", "text": "Iron deficiency", "correct": true}, {"label": "C", "text": "Folic acid deficiency", "correct": false}, {"label": "D", "text": "Hereditary spherocytosis", "correct": false}], "correct_answer": "B. Iron deficiency", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Microcytic Anaemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Normocytic Anaemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Macrocytic Anaemia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>S</strong>ideroblastic anemia.</li>\n<li><strong>I</strong>ron <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> anaemia.</li>\n<li><strong>T</strong>halassemia.</li>\n<li><strong>A</strong>nemia of chronic disease.</li>\n<li><strong>L</strong>ead poisoning.</li>\n</ul>\n<p> </p>\n<p><strong>(Mnemonic- SITAL)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Acute Blood Loss</li>\n<li>Hemolytic Anaemia(hereditary spherocytosis)</li>\n<li>Anemia of Chronic Disease</li>\n<li>Bone <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">Marrow</span> Disorders (e.g., <span class=\"customMeta\" data-dictid=\"1ea06afcbd1692777181199bfa3300\">Aplastic</span> Anaemia)</li>\n<li>Renal Disease</li>\n<li>Endocrine Disorders (e.g., Hypothyroidism)</li>\n<li>Early stages of iron <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> anaemia.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Vitamin B12 Deficiency</li>\n<li>Folate Deficiency</li>\n<li>Alcohol Abuse</li>\n<li>Liver Disease</li>\n<li>Hypothyroidism</li>\n<li>Myelodysplastic Syndrome</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 37-year-old woman presents with headaches for 6 months. She has been taking analgesics regularly. The headache recently increased in severity for 3 days but was reduced by stopping the analgesic. What is the likely diagnosis?", "options": [{"label": "A", "text": "Medication overuse headache", "correct": true}, {"label": "B", "text": "Tension headache", "correct": false}, {"label": "C", "text": "Chronic migraine", "correct": false}, {"label": "D", "text": "Cluster headache", "correct": false}], "correct_answer": "A. Medication overuse headache", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a 16-year-old girl who exhibits symptoms such as excessive familiarity, rapid flow of thoughts, heightened mood, heightened sexual desire, and experiencing pseudohallucinations?", "options": [{"label": "A", "text": "Mania", "correct": true}, {"label": "B", "text": "Hypomania", "correct": false}, {"label": "C", "text": "Cyclothymia", "correct": false}, {"label": "D", "text": "Schizomania", "correct": false}], "correct_answer": "A. Mania", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:726px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mania</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Mania </strong>is a mood disorder characterised by a distinct period of abnormally elevated, expansive, or <span class=\"customMeta\" data-dictid=\"31383b73d01692777190c6880a580b\">irritable</span> mood and increased energy or activity levels.</li>\n<li>Mania is a <strong>period of at least 1 week</strong> where a person's behaviour drastically changes and affects their functioning.</li>\n<li>Individuals experiencing <span class=\"customMeta\" data-dictid=\"51c142d5d116927771912526695796\">mania</span> engage in heightened goal-directed activity and may show <span class=\"customMeta\" data-dictid=\"67a8159af716927771964aa6043ac2\">psychomotor</span> agitation.</li>\n<li>Mania is a characteristic of <strong>Bipolar I disorder</strong>.</li>\n<li><strong>Symptoms (My <span class=\"customMeta\" data-dictid=\"ed36b5c18b1692777182d73ea85338\">Asia</span> FAST GDP</strong>)</li>\n</ul>\n<ul>\n<li><strong>M </strong>- Mood elevation</li>\n<li><strong>A</strong> - Activity levels Increased</li>\n<li><strong>F</strong> - Flight of ideas</li>\n<li><strong>A</strong> - Abnormally increased levels of activity/energy</li>\n<li><strong>S </strong>- Sleep decreased (Need for sleep is also reduced)</li>\n<li><strong>T</strong> - Talkativeness (Overtalkativeness)</li>\n<li><strong>G</strong> - <span class=\"customMeta\" data-dictid=\"2bf49be62516927771886ca6913e3e\">Grandiose</span> ideas and increased self-esteem</li>\n<li><strong>D </strong>- Distractibility</li>\n<li><strong>P</strong> - Painful consequences (Involvement in such activities</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnostic criteria </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>M</strong>ood Changes: Elation/ irritability</li>\n<li>Persistently increased <strong>E</strong>nergy</li>\n</ul>\n<p>+ ≥3 of the following symptoms (4 if <span class=\"customMeta\" data-dictid=\"31383b73d01692777190c6880a580b\">irritable</span> mood) for at least <strong>1 week</strong>:</p>\n\t\t\t \n\n\t\t\t<ul>\n<li><strong>D</strong>istractibility.</li>\n<li><strong>I</strong>mpulsivity/ high-risk activities</li>\n</ul>\n<ul>\n<li><strong>G</strong>randiosity/ Inflated Self-Esteem</li>\n<li><strong>F</strong>light of Ideas (Racing and expansive thoughts)</li>\n<li><strong>A</strong>ctivity increased (Hyperactivity)</li>\n<li><strong>S</strong>leep deficit (decreased need for sleep)</li>\n<li><strong>T</strong>alkativeness/ Pressured speech</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><br/>\n<br/>\n<br/>\n\t\t\t \n\t\t\t<p><strong>First line</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Monotherapy</strong>: <strong>Lithium</strong>, divalproex, and <strong>atypical antipsychotics</strong> such as olanzapine, risperidone, quetiapine, aripiprazole, cariprazine, asenapine, paliperidone, iloperidone, ziprasidone.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Adjunctive therapy</strong> with <span class=\"customMeta\" data-dictid=\"42659effea16927771919c6224e529\">lithium</span> or divalproex:</p>\n<p>Risperidone, quetiapine, olanzapine, aripiprazole, asenapine</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p><strong>Second line</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Monotherapy:</strong> <strong>Carbamazepine</strong>, <span class=\"customMeta\" data-dictid=\"bd9883da60169277718724f1610a52\">electroconvulsive</span> therapy (ECT), haloperidol.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Combination therapy: <span class=\"customMeta\" data-dictid=\"42659effea16927771919c6224e529\">Lithium</span> + Divalproex</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> \n\t\t\t<p><strong>Third line</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Monotherapy</strong>: <strong>Chlorpromazine</strong>, Clozapine, Tamoxifen</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Combination therapy:</strong> <span class=\"customMeta\" data-dictid=\"42659effea16927771919c6224e529\">lithium</span> or divalproex + haloperidol, <span class=\"customMeta\" data-dictid=\"42659effea16927771919c6224e529\">lithium</span> + carbamazepine, adjunctive tamoxifen</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:493px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mania</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypomania</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Severe symptoms</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less severe symptoms</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Duration ≥7 days</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Duration ≥4 days</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Marked <span class=\"customMeta\" data-dictid=\"4885d5d0021692777189aac6dc80f7\">impairment</span> in functioning</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No marked impairment</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hospitalisation might be required</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No hospitalisation necessitated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Psychotic symptoms can be seen</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No <span class=\"customMeta\" data-dictid=\"23702653681692777196e5c0fc63cd\">psychotic</span> symptoms</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Seen in <span class=\"customMeta\" data-dictid=\"df4ae006fe1692777183604169e9b2\">Bipolar</span> I &amp; II</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Seen in <span class=\"customMeta\" data-dictid=\"df4ae006fe1692777183604169e9b2\">Bipolar</span> II</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child was brought to OPD with palpable blanching purpura, abdominal pain, and pain in the knee joint. Urine examination showed hematuria and proteinuria. Whereas laboratory tests revealed normal platelet counts. What will be the most probable diagnosis?", "options": [{"label": "A", "text": "Immune thrombocytopenic purpura", "correct": false}, {"label": "B", "text": "Dengue", "correct": false}, {"label": "C", "text": "Churg-Strauss syndrome", "correct": false}, {"label": "D", "text": "Henoch-Schonlein purpura", "correct": true}], "correct_answer": "D. Henoch-Schonlein purpura", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - Henoch-Schonlein purpura</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Most common in males.</li>\n<li>Exact cause unknown.</li>\n<li>Immune-mediated vasculitis, often following an upper <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> infection.</li>\n<li>Genetic predisposition, with HLA-B34 and DRB1 observed in some cases.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathology and Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Inflammation of small vessels affecting skin, joints, intestines, and kidneys.</li>\n<li>Triggered by immune system response to infections.</li>\n<li>Leakage of fluid and blood cells into tissues.</li>\n<li>Immune complex deposition, particularly <strong>IgA</strong>, in affected vessels.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Palpable Purpura:</strong> Raised, purplish-red rash, mainly on legs and buttocks</li>\n<li><strong>Joint Involvement:</strong> Joint swelling, commonly in knees and ankles.</li>\n<li><strong>Abdominal Pain: </strong>Often include vomiting, diarrhea, <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> bleeding, or intussusception<strong>.</strong></li>\n<li><strong>Renal Involvement:</strong> Less common, presents as Chronic <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Criteria: </strong></p>\n<p><strong>Palpable <span class=\"customMeta\" data-dictid=\"0acd34c758169277719644923511e5\">purpura</span> plus at least one</strong> <strong>of the following:</strong></p>\n<ul>\n<li>Diffuse <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain</li>\n<li>Arthritis or arthralgia</li>\n<li>Biopsy-proven <span class=\"customMeta\" data-dictid=\"68bae589ad169277718918627baff4\">IgA</span> deposition</li>\n<li>Renal involvement</li>\n</ul>\n<p><strong>Laboratory involvement:</strong></p>\n<ul>\n<li><strong>Elevated</strong> <span class=\"customMeta\" data-dictid=\"49069760291692777187e0e72db819\">ESR</span> or <span class=\"customMeta\" data-dictid=\"4df81a22571692777185a288d3c63d\">CRP</span> indicating inflammation.</li>\n<li><strong>Platelet Counts are normal.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Intussusception.</li>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure due to long term <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> damage, in severe cases.</li>\n<li>Neurological complications: Rare; may include seizures, headaches, or <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> neuropathy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Mild Cases: Rest, hydration, and pain relievers.</li>\n<li>Moderate to Severe Cases: Corticosteroids (e.g., prednisone) to reduce inflammation.</li>\n<li>Severe or Resistant Cases: Additional <span class=\"customMeta\" data-dictid=\"c3c986cd721692777189b473814b2e\">immunosuppressive</span> medications may be required.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A chronic alcoholic patient presented with increasing abdominal girth. On examination, shifting dullness was present, and the liver span was less than 7cm. Histopathological examination revealed the presence of intracytoplasmic eosinophilic inclusions in hepatocytes. What is the content of these inclusions?", "options": [{"label": "A", "text": "Intermediate filaments", "correct": true}, {"label": "B", "text": "Actin", "correct": false}, {"label": "C", "text": "Microtubules", "correct": false}, {"label": "D", "text": "Fibronectin", "correct": false}], "correct_answer": "A. Intermediate filaments", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/pWreZkynQrbLC74d2gz91746443459.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old female patient is diagnosed with pure red cell aplasia and a mediastinal mass. Which of the following is a likely cause?", "options": [{"label": "A", "text": "Thymoma", "correct": true}, {"label": "B", "text": "Non-Hodgkin lymphoma", "correct": false}, {"label": "C", "text": "Bronchogenic carcinoma", "correct": false}, {"label": "D", "text": "Germ cell tumour", "correct": false}], "correct_answer": "A. Thymoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/2guyo8TpeGUZnKppt53t1745411208.png", "https://image.prepladder.com/notes/hpHqSTQzK0KEFpwPTjWe1746444391.png", "https://image.prepladder.com/notes/Mdmc22Lfu0Ox21AjqGCw1746444425.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:1000px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Thymoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Mostly <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> (small tumor), incidentally detected.</li>\n<li>It may <span class=\"customMeta\" data-dictid=\"c6486470671692777184e25019e1f0\">compress</span> the <span class=\"customMeta\" data-dictid=\"9ebd78bd471692777200ede69e8ed1\">trachea</span> (dyspnea), <span class=\"customMeta\" data-dictid=\"6a729a105a169277718788389dbeab\">esophagus</span> (dysphagia), <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> laryngeal nerve (dysphonia or <span class=\"customMeta\" data-dictid=\"4da1fe73a71692777189ec55b7ed8c\">hoarseness</span> of voice), and superior <span class=\"customMeta\" data-dictid=\"3ddf6d5ea71692777201b70c8b9715\">vena</span> <span class=\"customMeta\" data-dictid=\"67544ba6ef16927771835d4641cc8f\">cava</span> (superior <span class=\"customMeta\" data-dictid=\"3ddf6d5ea71692777201b70c8b9715\">vena</span> <span class=\"customMeta\" data-dictid=\"67544ba6ef16927771835d4641cc8f\">cava</span> syndrome).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CT scan</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Investigation of choice</li>\n<li>It is used to determine the extent of the disease.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Mohankumar Kurukumbi, Roger L Weir, Janaki Kalyanam, Mansoor Nasim, Annapurni Jayam-Trouth., CC BY 2.0 &lt;https://creativecommons.org/licenses/by/2.0&gt;, via Wikimedia Commons\" data-hash=\"\" data-license=\"CC BY 2.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Anterior_mediastinal_mass_thymoma_diagram.jpg\" data-tags=\"\" height=\"243\" src=\"https://image.prepladder.com/content/2guyo8TpeGUZnKppt53t1745411208.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histology</strong> <strong>(definitive diagnosis)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Noninvasive thymomas:</strong> Medullary-type epithelial cells (elongated or spindle-shaped) or a mixture of medullary- and cortical-type epithelial cells (admixture of polygonal cortical-type epithelial cells and a denser <span class=\"customMeta\" data-dictid=\"8fd5e2898d16927771900855b98180\">infiltrate</span> of thymocytes).</li>\n</ul>\n<p style=\"text-align:center\"> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Non-invasive Thymoma\" data-author=\"Roden AC\" data-hash=\"11973\" data-license=\"NA\" data-source=\"https://www.pathologyoutlines.com/topic/mediastinumthymoma.html\" data-tags=\"May2025\" height=\"225\" src=\"https://image.prepladder.com/notes/hpHqSTQzK0KEFpwPTjWe1746444391.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Invasive thymoma:</strong> Cytologically <span class=\"customMeta\" data-dictid=\"1bbae82f1f16927771824f797639fa\">benign</span> but locally invasive. The epithelial cells have abundant <span class=\"customMeta\" data-dictid=\"728bb228361692777185b98c34534b\">cytoplasm</span> and rounded <span class=\"customMeta\" data-dictid=\"4b0fee14c816927772016e67cf3a13\">vesicular</span> <span class=\"customMeta\" data-dictid=\"e6b47028191692777193eb698e43b6\">nuclei</span> mixed with numerous thymocytes.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Invasive Thymoma\" data-author=\"Librepath\" data-hash=\"11975\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Thymoma_type_B1_--_very_high_mag.jpg\" data-tags=\"May2025\" height=\"201\" src=\"https://image.prepladder.com/notes/Mdmc22Lfu0Ox21AjqGCw1746444425.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Cytokeratin</strong> (marker to distinguish <span class=\"customMeta\" data-dictid=\"76ecb330ba169277720078d984ef2a\">thymoma</span> from lymphoma; thymomas are positive for cytokeratin)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/zseuvBpW1YY9QGssgSpo1749401666.mp3", "video": ""}, {"text": "A 15-year-old patient with a history of spinal tuberculosis was brought to the hospital with low-grade fever, dull backache, and persistent flexion of the hip joint. Hip joint motion was limited and painful. Identify the muscle affected in the CT image.", "options": [{"label": "A", "text": "1", "correct": false}, {"label": "B", "text": "2", "correct": true}, {"label": "C", "text": "3", "correct": false}, {"label": "D", "text": "4", "correct": false}], "correct_answer": "B. 2", "question_images": ["https://image.prepladder.com/notes/vRNYNjglZUXQGhyzAKME1746444603.png"], "explanation_images": ["https://image.prepladder.com/notes/tEt7sJJheJLi5MFgbNnv1746444633.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:668px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Spinal TB (Pott’s Disease)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involves lower <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> and upper <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">lumbar</span> <span class=\"customMeta\" data-dictid=\"9c0b99fa0816927772010e947b4ef6\">vertebrae</span> in adults; and upper <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> spine in children.</p>\n<p>Lesions spread to adjacent <span class=\"customMeta\" data-dictid=\"9c0b99fa0816927772010e947b4ef6\">vertebrae</span> and <span class=\"customMeta\" data-dictid=\"95a8e326831692777190c5101eb835\">intervertebral</span> disks.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Advanced Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Collapse of <span class=\"customMeta\" data-dictid=\"9c0b99fa0816927772010e947b4ef6\">vertebrae</span> leads to <span class=\"customMeta\" data-dictid=\"67deccee6a16927771911e0dcd1c3c\">kyphosis</span> <strong>(gibbus deformity)</strong>.</li>\n<li>Paravertebral cold abscesses:\n\t\t\t\t<ul>\n<li><strong>Upper spine: </strong>Abscess may<strong> penetrate the <span class=\"customMeta\" data-dictid=\"06e0403a9c16927771846fde1c53f8\">chest wall</span> as a soft tissue mass.</strong></li>\n<li><strong>Lower spine: </strong>May track to<strong> the inguinal region or <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> a <span class=\"customMeta\" data-dictid=\"1ca45620ed1692777196a47f648338\">psoas</span> abscess.</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis of <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">Spinal</span> TB</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Imaging (CT/MRI): </strong>Shows characteristic lesions, suggesting TB aetiology.</li>\n<li>Differential Diagnosis: Includes tumours and infections like <span class=\"customMeta\" data-dictid=\"f6332ef2d21692777196294f154e57\">pyogenic</span> bacterial osteomyelitis.</li>\n<li>Confirmation: <strong>Aspiration or <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> confirms TB</strong> via positive cultures and typical histology.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Paraplegia</strong>: Due to <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> or <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord compression; requires emergency <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> if caused by a large abscess.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a child presenting with infantile hypertrophic pyloric stenosis, what metabolic abnormality is commonly observed, given the presence of recurrent episodes of non-bilious vomiting?", "options": [{"label": "A", "text": "Hypochloremic hypokalemic acidosis", "correct": false}, {"label": "B", "text": "Hypochloremic hypokalemic alkalosis", "correct": true}, {"label": "C", "text": "Hypokalemic hyperchloremic alkalosis", "correct": false}, {"label": "D", "text": "Hyperchloremic hypokalemic acidosis", "correct": false}], "correct_answer": "B. Hypochloremic hypokalemic alkalosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/tXQDwz36qd8vKOwWNg6j1746444117.png", "https://image.prepladder.com/notes/3cWi62q1F8NVRWBtTY3w1746444032.png"], "explanation": "<p>Correct Answer B - Hypochloremic &lt;span class=\"customMeta\" data-dictid=\"ca346360e1169277718995a1e81f6f\"&gt;hypokalemic&lt;/span&gt; alk\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 34-year-old female patient presented to the outpatient department with migratory arthritis, and examination revealed a pan-systolic murmur. An echocardiography was performed, which was suggestive of mitral regurgitation. A biopsy specimen was obtained, and the image is provided below. What is the most likely lesion shown in the histopathology slide?", "options": [{"label": "A", "text": "Aschoff’s bodies", "correct": true}, {"label": "B", "text": "Epithelioid granuloma", "correct": false}, {"label": "C", "text": "Granulomatous vasculitis", "correct": false}, {"label": "D", "text": "Granuloma inguinale", "correct": false}], "correct_answer": "A. Aschoff’s bodies", "question_images": ["https://image.prepladder.com/content/WQXOwPoCRKEzJb5vnai61745411278.png"], "explanation_images": ["https://image.prepladder.com/content/F6HfGdokKglXLo4kZEPv1745411323.png", "https://image.prepladder.com/content/dsAPAvd083qNxMCXnIir1745411329.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:600px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Histopathological features of RHD</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Aschoff bodies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>They<strong> </strong>are <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> areas of <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> with <span class=\"customMeta\" data-dictid=\"669bdcb3111692777190e018ae930e\">infiltration</span> of lymphocytes, <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> cells and activated macrophages or histiocytes.</li>\n<li>An <span class=\"customMeta\" data-dictid=\"9ec09a7cfc169277718700e4dcac4e\">endomyocardial</span> <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> showing Aschoff's bodies helps in confirming the diagnosis of RHD.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Nephron\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Rheumatic_heart_disease_-_3b_-_very_high_mag.jpg\" data-tags=\"\" height=\"207\" src=\"https://image.prepladder.com/content/F6HfGdokKglXLo4kZEPv1745411323.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Anitschkow cells</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>They<strong> </strong>are activated macrophages with elongated and wavy <span class=\"customMeta\" data-dictid=\"e6b47028191692777193eb698e43b6\">nuclei</span> commonly found within Aschoff bodies.</li>\n<li>They appear as caterpillars in <span class=\"customMeta\" data-dictid=\"7ba18aa5e616927771918a45051a40\">longitudinal</span> sections <strong>(hence also called <span class=\"customMeta\" data-dictid=\"526cf2c9fd16927771835ecd31fb31\">Caterpillar</span> cells)</strong> and owls in cross sections.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Ed Uthman\" data-hash=\"\" data-license=\"CC BY SA 2.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Anitschkow_Myocytes_in_an_Aschoff_Body,_Rheumatic_Myocarditis.jpg\" data-tags=\"\" height=\"314\" src=\"https://image.prepladder.com/content/dsAPAvd083qNxMCXnIir1745411329.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fibrinoid <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>This is<strong> </strong>seen in areas of the valves affected by inflammation.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Granulation tissue is seen in cases of repair. It comprises proliferating blood vessels, <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> cells and fibroblasts.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A diabetic woman is admitted due to persistent vomiting. She gives a history of consuming food from outside. On evaluation, her blood pressure is 90/60 mmHg. Her arterial blood gas (ABG) report shows the following findings. What is the cause of her ABG findings? pH - 7.52 HCO 3 - 30 meq/L PaCO 2 - 20 mmHg Na- 123 mEq/L K- 3.2 mEq/L CI- 67 mEq/L", "options": [{"label": "A", "text": "Diabetic ketoacidosis", "correct": false}, {"label": "B", "text": "Persistent vomiting", "correct": true}, {"label": "C", "text": "Septic shock", "correct": false}, {"label": "D", "text": "Renal tubular acidosis", "correct": false}], "correct_answer": "B. Persistent vomiting", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A pap smear taken from a patient revealed hyperchromatic nuclei, irregular nuclear borders, and a low maturation index involving the whole thickness but did not breach the basement membrane. What is the diagnosis?", "options": [{"label": "A", "text": "Dysplasia", "correct": true}, {"label": "B", "text": "Carcinoma", "correct": false}, {"label": "C", "text": "Metaplasia", "correct": false}, {"label": "D", "text": "Hyperplasia", "correct": false}], "correct_answer": "A. Dysplasia", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/fGyxDfL8E6TcqCcfQb5R1749401813.mp3", "video": ""}, {"text": "A 36-year-old woman presented with claudication in the forearm, transient loss of vision, and abdominal pain. Femoral pulses were weak. Fundus examination revealed retinal haemorrhages. What is the likely diagnosis?", "options": [{"label": "A", "text": "Polyarteritis nodosa", "correct": false}, {"label": "B", "text": "Thromboangitis obliterans", "correct": false}, {"label": "C", "text": "Takayasu arteritis", "correct": true}, {"label": "D", "text": "Microscopic polyangiitis", "correct": false}], "correct_answer": "C. Takayasu arteritis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 6-year-old girl, born out of a non-consanguineous marriage, presented with rachitic changes in her limbs since the age of 2 despite receiving several rounds of vitamin D treatment. Investigations are shown below. What is the most likely diagnosis? Parameter Lab determined value Serum Calcium 9.5 mg/dL Serum Phosphate 1.6 mg/dL ALP 814 IU PTH Within normal limits Serum electrolytes Within normal limits Serum creatinine Within normal limits ABG Within normal limits", "options": [{"label": "A", "text": "Vitamin D-dependent rickets", "correct": false}, {"label": "B", "text": "Hypoparathyroidism", "correct": false}, {"label": "C", "text": "Chronic renal failure", "correct": false}, {"label": "D", "text": "Hypophosphatemic rickets", "correct": true}], "correct_answer": "D. Hypophosphatemic rickets", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/kTKZq7U51GR782bN28YH1745411567.png"], "explanation": "<p>Correct Answer D - Hypophosphatemic rickets</p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Disorder </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Calcium</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"25\" src=\"https://image.prepladder.com/content/kTKZq7U51GR782bN28YH1745411567.png\" width=\"42\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>PTH</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>ALP</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>25-(OH)D</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>1,25-(OH)D</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Urine Calcium</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Vitamin D <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">N,￬</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">￬</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">￪</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">￪</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">￬</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">￬,N,￪</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">￬</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Vitamin D dependent <span class=\"customMeta\" data-dictid=\"3bbd4ac09b16927771974d75a8b355\">rickets</span> <span class=\"customMeta\" data-dictid=\"ebcb7136251692777201ef4b5c5718\">Type 1</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">N,￬</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">￬</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">￪</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">￪</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">N,￬</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">N,￬</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">￬</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Vitamin D dependent ricketsType 2 </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">N,￬</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">￬</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">￪</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">￪</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">N</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">￪￪</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">￬</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Chronic <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">N,￬</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">￪</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">￪</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">￪</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">N</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">￬</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">N,￬</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>X- <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> hypophosphatemic rickets</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">N</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">￬</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">N,￪</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">￪</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">N</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">￬</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">￬</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Autosomal dominant <span class=\"customMeta\" data-dictid=\"2dc806de3f1692777189cfcd27ce71\">hypophosphatemic rickets</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">N</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">￬</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">N</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">￪</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">N</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">￬</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">￬</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Hereditary <span class=\"customMeta\" data-dictid=\"2dc806de3f1692777189cfcd27ce71\">hypophosphatemic rickets</span> with hypercalciuria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">N</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">￬</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">N,￬</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">￪</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">N</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">￪</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">￪</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Autosomal <span class=\"customMeta\" data-dictid=\"d54db2110416927771971e7c011a9f\">recessive</span> hypophosphatemic rickets</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">N</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">￬</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">N</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">￪</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">N</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">￬</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">￬</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Dietary <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> deficiency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">N,￬</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">￬</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">￪</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">￪</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">N</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">￪</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">￬</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A woman with hysteria who was hyperventilating developed carpo-pedal spasms. What could be the likely cause for this?", "options": [{"label": "A", "text": "Respiratory acidosis", "correct": false}, {"label": "B", "text": "Metabolic acidosis", "correct": false}, {"label": "C", "text": "Respiratory alkalosis", "correct": true}, {"label": "D", "text": "Metabolic alkalosis", "correct": false}], "correct_answer": "C. Respiratory alkalosis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cause</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neurological</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Dizziness</li>\n<li>Mental confusion</li>\n<li>Paresthesias</li>\n<li>Circumoral numbness</li>\n<li>Seizures (severe cases)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Due to <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> cerebral blood flow</li>\n<li>From rapid ↓ PaCO<sub>2</sub></li>\n<li>May occur without hypoxemia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cardiovascular</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Chest tightness/pain</li>\n<li>Palpitations</li>\n<li>Arrhythmias</li>\n<li>Possible <span class=\"customMeta\" data-dictid=\"40ebcbf95e169277718613d7c2d999\">ECG</span> changes</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Due to <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> vasoconstriction</li>\n<li>↓ ionized <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> effects</li>\n<li>Bohr effect on O<sub>2</sub> delivery</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neuromuscular</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Carpopedal spasms</strong></li>\n<li>Tetany</li>\n<li>Muscle twitching</li>\n<li>Weakness</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>From ↓ ionized calcium</li>\n<li>Enhanced nerve excitability</li>\n<li>Similar to hypocalcemia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Laboratory</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>↑ pH</li>\n<li>↓ PaCO<sub>2</sub></li>\n<li>↓ Ionized calcium</li>\n<li>↓ K+, ↓ PO<sub>4</sub></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Acute: ↓ HCO<sub>3</sub>- by 2 mEq/L per 10 mmHg ↓ PaCO<sub>2</sub></li>\n<li>Chronic: ↓ HCO<sub>3</sub>- by 4-5 mEq/L per 10 mmHg ↓ PaCO<sub>2</sub></li>\n<li>Electrolyte shifts into cells</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Underlying Disease:</strong></p>\n<ul>\n<li>Treat primary condition</li>\n<li>Address anxiety if present</li>\n<li>Manage <span class=\"customMeta\" data-dictid=\"fe9ab8afe416927771980091186846\">sepsis</span> if present</li>\n</ul>\n\t\t\t \n\n\t\t\t<p><strong>Hyperventilation Syndrome:</strong></p>\n<ul>\n<li>Reassurance</li>\n<li>Rebreathing techniques</li>\n<li>Paper bag breathing if needed</li>\n<li>β-blockers if needed</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Primary focus on the underlying cause</li>\n<li>Avoid sedatives for anxiety</li>\n<li>Monitor during mechanical ventilation</li>\n<li>Adjust <span class=\"customMeta\" data-dictid=\"072a58ab7d169277720130e58f9614\">ventilator</span> settings if needed</li>\n<li>Regular monitoring of blood gases</li>\n<li>Address psychological factors</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During the anthropometric evaluation of the child, the height for the age is &amp;lt; -2 SD according to WHO growth charts. This is most likely due to:", "options": [{"label": "A", "text": "Chronic malnutrition", "correct": true}, {"label": "B", "text": "Acute malnutrition", "correct": false}, {"label": "C", "text": "Recent infection", "correct": false}, {"label": "D", "text": "No malnutrition", "correct": false}], "correct_answer": "A. Chronic malnutrition", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - Chronic malnutrition:</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Moderately underweight</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Weight for age is between -2 and -3 SD.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Severely underweight</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Weight for age is &lt; -3 SD.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Moderately wasted</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Weight for length/height is between -2 and -3 SD.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Severely wasted</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Weight for length/height is &lt; -3 SD.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Moderate <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> Malnutrition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Weight-for-length/height or <span class=\"customMeta\" data-dictid=\"765e9149d01692777183c3989c6590\">BMI</span> for age is between -2 and -3 SD.</li>\n<li>Mid-upper arm <span class=\"customMeta\" data-dictid=\"0e190b1ed716927771848781259060\">circumference</span> (MUAC) is between 11.5 cm and 12.5 cm.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Severe <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> <span class=\"customMeta\" data-dictid=\"cbd2d1fd521692777191d00c1a4ede\">Malnutrition</span> (SAM) :</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Weight-for-length/height or BMI-for-age is less than -3SDS.</li>\n<li>MUAC is less than 11.5 cm.</li>\n<li>The presence of <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> <span class=\"customMeta\" data-dictid=\"a8c53e6875169277719588cd709854\">pitting</span> oedema.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Moderately Stunted (Moderate Chronic Malnutrition)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Length/height for age</strong> is between -2 and -3 SD.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Severely Stunted (Severe Chronic Malnutrition)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Length/height for age</strong> is &lt; -3 SD.</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 12-week-old child presented with fever, cyanosis, and fatigue. His chest X-ray is shown below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Total anomalous pulmonary venous circulation", "correct": true}, {"label": "B", "text": "Tetralogy of Fallot", "correct": false}, {"label": "C", "text": "Transposition of great arteries", "correct": false}, {"label": "D", "text": "Pericardial effusion", "correct": false}], "correct_answer": "A. Total anomalous pulmonary venous circulation", "question_images": ["https://image.prepladder.com/content/lJ8hOGhYjYwYBwvPhNbS1748200258.png"], "explanation_images": ["https://image.prepladder.com/content/gs6hZkDRhtbFyExSyeUv1745412460.png", "https://image.prepladder.com/content/ijzwd7LCSPmFKNcYfwwv1745412477.png", "https://image.prepladder.com/content/F8sWpzBnka8PPky6pOKt1745412487.png", "https://image.prepladder.com/content/MQVJUrhRhRUuCVQtXGq91745412499.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:590px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Total <span class=\"customMeta\" data-dictid=\"11b0cdbdbd1692777181cffbe7aa1b\">Anomalous</span> <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">Venous</span> Connection (TAPVC)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Pulmonary veins drain into the right <span class=\"customMeta\" data-dictid=\"a8d33da8541692777182ec6983d9a2\">atrium</span> directly or indirectly via an <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> connection</li>\n<li>Not a ductal-dependent cyanotic lesion</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sites of <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> connection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Supracardiac- superior <span class=\"customMeta\" data-dictid=\"3ddf6d5ea71692777201b70c8b9715\">vena</span> <span class=\"customMeta\" data-dictid=\"67544ba6ef16927771835d4641cc8f\">cava</span> (Most common)</li>\n<li>Cardiac-coronary sinus, right atrium</li>\n<li>Infracardiac</li>\n<li>Mixed</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cyanosis and congestive <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> failure</li>\n<li>With ASD- wide and split S2</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Chest X-ray</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Snowman or figure-8 <span class=\"customMeta\" data-dictid=\"1792af7b92169277718423182d599d\">configuration</span> in supracardiac TAPVC</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Ian Bickle\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/snowman-sign-1\" data-tags=\"\" height=\"361\" src=\"https://image.prepladder.com/content/gs6hZkDRhtbFyExSyeUv1745412460.png\" width=\"361\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Surgery</li>\n<li>No indication for prostaglandins (Not a ductal-dependent cyanotic lesion)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a child who exhibits generalized swelling and is diagnosed with high cholesterol levels, as well as protein 3+ and fat bodies observed in urine analysis?", "options": [{"label": "A", "text": "Nephrotic syndrome", "correct": true}, {"label": "B", "text": "Nephritic syndrome", "correct": false}, {"label": "C", "text": "Goodpasture's disease", "correct": false}, {"label": "D", "text": "lgA nephropathy", "correct": false}], "correct_answer": "A. Nephrotic syndrome", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - &lt;span class=\"customMeta\" data-dictid=\"7063996c3816927771930f70c92eb4\"&gt;Nephrotic&lt;/span&gt; Syndrome:</p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Nephrotic syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Nephritic syndrome (Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Edema, heavy proteinuria</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hematuria, oliguria, edema, hypertension</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Proteinuria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Heavy <strong>(3+ to 4+)</strong> on dipstick</p>\n<p>(&gt;3.5gm/24 hour)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>(1+ to 2+) </strong> levels of <span class=\"customMeta\" data-dictid=\"1f58deccf71692777196e64781a01a\">proteinuria</span> (&lt;1gm/ 24-hour)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hematuria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rare,<strong> <span class=\"customMeta\" data-dictid=\"79067cb33316927771926965c3c0b5\">microscopic</span> hematuria</strong> may occur</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common, with<strong> cola-colored <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> </strong>due to gross hematuria</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Urinary Casts</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hyaline and <span class=\"customMeta\" data-dictid=\"4f63eb15be169277718848d4b4978b\">granular</span> casts</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Red blood cell casts</strong> (indicating <span class=\"customMeta\" data-dictid=\"1ad1e71a4a1692777188853097f685\">glomerular</span> inflammation)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Serum Albumin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low (&lt;1 g/dL)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Usually<strong> normal</strong> unless severe <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> impairment</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Blood <span class=\"customMeta\" data-dictid=\"38d4be106e169277720105b006c26b\">Urea</span> and Creatinine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Normal</strong> unless <span class=\"customMeta\" data-dictid=\"b93b1c964f16927771894edc409f80\">hypovolemia</span> or <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> injury</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Elevated</strong> due to impaired <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> function</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Serum <span class=\"customMeta\" data-dictid=\"f0ff39a3fa1692777184cf743ca1e7\">Complement</span> C3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Low </strong>in 90% of cases, returns to normal in 8-12 weeks</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cholesterol</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hypercholesterolemia </strong>(may cause <span class=\"customMeta\" data-dictid=\"70da66640f16927771920de556da59\">milky</span> plasma)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No significant hypercholesterolemia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>ASO/Anti-DNase B Titers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Not elevated</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Elevated <span class=\"customMeta\" data-dictid=\"3e7108fe871692777182786921689e\">ASO</span> titers </strong>(pharyngitis) or anti-DNase B (skin infection)</p>\n</td>\n</tr>\n</tbody>\n\n<table align=\"left\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Nephrotic syndrome </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Nephritic syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Massive proteinuria</li>\n<li>Lipiduria</li>\n<li>Hypoalbuminemia</li>\n<li>Edema</li>\n<li>Thrombotic events</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Mild proteinuria</li>\n<li>Hypertension</li>\n<li>Oliguria</li>\n<li>Hematuria</li>\n<li>Azotemia</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Leiden mutation is of factor:", "options": [{"label": "A", "text": "V", "correct": true}, {"label": "B", "text": "VIII", "correct": false}, {"label": "C", "text": "I", "correct": false}, {"label": "D", "text": "X", "correct": false}], "correct_answer": "A. V", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient following a skid resulting in a motor traffic accident was brought to the emergency room 2 hours later. On examination, he was stable with GCS 15/15. The pupil was reactive to light. Tenderness and bruising over the left lower chest wall with petechiae were seen. Severe tenderness was elicited in the left hypochondriac region and BP-90/50 mm of Hg. What is the best investigation used in the ER? GCS: Glasgow coma scale FAST: Focused Assessment with Sonography for Trauma", "options": [{"label": "A", "text": "FAST", "correct": true}, {"label": "B", "text": "X-ray", "correct": false}, {"label": "C", "text": "Diagnostic peritoneal lavage", "correct": false}, {"label": "D", "text": "CT scan", "correct": false}], "correct_answer": "A. FAST", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/muYdZpo3r64ZdFWR6UHQ1745412904.png", "https://image.prepladder.com/notes/Odcipis6eBljnXyy1Mps1746445168.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most effective way to verify the placement of the endotracheal tube in a 30-year-old male patient who has been intubated for surgery by a final-year resident?", "options": [{"label": "A", "text": "X-ray chest", "correct": false}, {"label": "B", "text": "Auscultation", "correct": false}, {"label": "C", "text": "End-tidal CO₂ concentration", "correct": true}, {"label": "D", "text": "Chest rise", "correct": false}], "correct_answer": "C. End-tidal CO₂ concentration", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with abdominal pain and distension. An X-ray was taken which showed dilated bowel loops as given in the image below. Identify the segment involved.", "options": [{"label": "A", "text": "Jejunum", "correct": true}, {"label": "B", "text": "Ileum", "correct": false}, {"label": "C", "text": "Duodenum", "correct": false}, {"label": "D", "text": "Transverse colon", "correct": false}], "correct_answer": "A. Jejunum", "question_images": ["https://image.prepladder.com/notes/99BzGrO2WOSr4wWZShsN1746445432.png"], "explanation_images": ["https://image.prepladder.com/notes/W6nt1sROfWemcsePKeDv1746445466.png", "https://image.prepladder.com/content/2SPJKMYcRZvYUO1TGZQ61745413357.png", "https://image.prepladder.com/notes/8vjV7K5VIXWIAv0t3qcA1746445666.png", "https://image.prepladder.com/content/P9XlA2JI8uMqHi7aUfs31745413631.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Jejunum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Plicae circulares or <span class=\"customMeta\" data-dictid=\"775b64181b1692777201c6ab88b10e\">valvulae</span> conniventes</strong></p>\n<ul>\n<li>Visible as circumferential, ring-like patterns.</li>\n<li>Multiple dilated <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> loops.</li>\n<li>Loops are centrally located.</li>\n<li>The mucosal pattern appears well-defined with a “feathery” appearance due to the <span class=\"customMeta\" data-dictid=\"33864cf9a5169277719571e0fdfb61\">plicae</span> circulares.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ileum</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dilated <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> loops.</strong></p>\n<ul>\n<li>Loops are centrally located.</li>\n<li>Featureless or “characteristically characterless” appearance, lacking the pronounced mucosal pattern seen in the jejunum.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old man presents with a history of recurrent retrosternal chest pain, with each episode lasting for 3-5 min and subsiding with sublingual nitrate. ECG shows left ventricular hypertrophy and flat T-wave. He has a known case of hypertension, diabetes mellitus, and hypercholesterolemia and is currently on aspirin, atenolol, metformin, and lovastatin. What is the next best step in management?", "options": [{"label": "A", "text": "IV glyceryl trinitrate infusion", "correct": false}, {"label": "B", "text": "Injection enoxaparin", "correct": true}, {"label": "C", "text": "Add clopidogrel", "correct": false}, {"label": "D", "text": "Increase the dose of beta blocker", "correct": false}], "correct_answer": "B. Injection enoxaparin", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Medical management</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anti-ischemic therapy:</strong></p>\n<ul>\n<li><strong>Sublingual <span class=\"customMeta\" data-dictid=\"2da084cc151692777188fe899c0c5f\">glyceryl</span> trinitrate/nitroglycerin:</strong>\n<ul>\n<li><strong>DOC</strong> for unstable angina</li>\n<li>For <strong>ischemic discomfort </strong></li>\n</ul>\n</li>\n<li><strong>IV beta-blockers</strong> (Atenolol, Metoprolol):\n\t\t\t\t<ul>\n<li>They <strong>reduce the oxygen demand of the myocardium</strong></li>\n<li>They relieve pain, reduce arrhythmias, and reduce short-term mortality</li>\n</ul>\n</li>\n<li><strong>Verapamil and diltiazem:</strong>\n<ul>\n<li>Given if symptoms are not relieved by full dose <span class=\"customMeta\" data-dictid=\"806eb8418c16927771822855b56695\">beta</span> blockers and nitrates</li>\n<li>They decrease the heart rate</li>\n</ul>\n</li>\n<li><strong>IV <span class=\"customMeta\" data-dictid=\"27d6d97dc51692777192f1043b6a79\">morphine</span> <span class=\"customMeta\" data-dictid=\"535af9a2181692777199309af44d24\">sulfate</span> or diamorphine:</strong>\n<ul>\n<li>For analgesia</li>\n</ul>\n</li>\n<li><strong>Antiemetics </strong>like<strong> metoclopramide</strong> (For <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> relief)</li>\n<li>Nifedipine or amlodipine (If chest discomfort persists)</li>\n<li><strong>Atorvastatin and other HMG-CoA <span class=\"customMeta\" data-dictid=\"6afb2667fe16927771975a8db1378b\">reductase</span> inhibitors:</strong> Reduces occurrence of MI and recurrences of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> syndrome</li>\n<li>Ezetimibe or alirocumab, evolocumab:\n\t\t\t\t<ul>\n<li>Given if unresponsive to full dose statins</li>\n<li>They reduce <span class=\"customMeta\" data-dictid=\"4e4438ab5c16927771919ca536a59f\">LDL</span> cholesterol and prevent further <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> events</li>\n</ul>\n</li>\n</ul>\n<p><strong>Antithrombotic therapy: </strong></p>\n<ul>\n<li>Antiplatelet drugs:\n\t\t\t\t<ul>\n<li>Cyclooxygenase inhibitor: aspirin</li>\n<li>Platelet P2Y12 <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> inhibitor: clopidogrel</li>\n</ul>\n</li>\n</ul>\n<p><strong>Anticoagulants:</strong></p>\n<ul>\n<li>Unfractionated heparin.</li>\n<li><strong>Low molecular heparin: Enoxaparin.</strong></li>\n<li>Direct <span class=\"customMeta\" data-dictid=\"ac7e1f394f1692777200c5bb11e4d8\">thrombin</span> inhibitor: bivalirudin.</li>\n<li>Synthetic factor Xa inhibitor: fondaparinux.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Invasive management</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Done if the medical management fails and symptoms do not improve.</li>\n<li>Coronary <span class=\"customMeta\" data-dictid=\"baea202dec1692777182a0723c23ea\">arteriography</span> must be done within 48 hours of presentation.</li>\n<li>Coronary revascularisation includes <strong>PCI (percutaneous <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> intervention)</strong> or <strong>coronary <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> <span class=\"customMeta\" data-dictid=\"4fc6b3ee501692777183061d4f55ff\">bypass</span> <span class=\"customMeta\" data-dictid=\"6ca773c032169277718858b8ad1e9c\">grafting</span> (CABG)</strong>.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child with acute lymphoblastic leukemia undergoes prophylactic irradiation prior autologous hematopoietic stem cell transplantation. Which of the following will be the least affected?", "options": [{"label": "A", "text": "Spermatogonia", "correct": false}, {"label": "B", "text": "Intestinal epithelial cells", "correct": false}, {"label": "C", "text": "Neurons", "correct": true}, {"label": "D", "text": "Bone marrow/ erythroid precursor cells", "correct": false}], "correct_answer": "C. Neurons", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/P7mJJWUGf5HAkupbBxzT1746445894.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young child with congenital hydrocephalus was treated with a successful ventriculoperitoneal (VP) shunt. Four months post-surgical repair, the child presented with fever, nuchal rigidity, and irritability. Suspecting meningitis, which of the following is the next best step of management?", "options": [{"label": "A", "text": "Wait and watch", "correct": false}, {"label": "B", "text": "Check shunt patency by nuclear study", "correct": false}, {"label": "C", "text": "Blood culture and take CSF sample from shunt tap", "correct": true}, {"label": "D", "text": "Blood culture and take CSF sample by lumbar puncture", "correct": false}], "correct_answer": "C. Blood culture and take CSF sample from shunt tap", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - &lt;span class=\"customMeta\" data-dictid=\"590c4f61381692777183624596f6ed\"&gt;Blood culture&lt;/span&gt; and take &lt;span class=\"customMeta\" data-dictid=\"123c47549916927771854892334fb9\"&gt;CSF&lt;/span&gt; sample from &lt;span class=\"customMeta\" data-dictid=\"950826ab361692777198366a25dfbf\"&gt;shunt&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following vessels is responsible for returning deoxygenated blood back to the placenta in fetal circulation?", "options": [{"label": "A", "text": "Umbilical Vein", "correct": false}, {"label": "B", "text": "Umbilical artery", "correct": true}, {"label": "C", "text": "Descending aorta", "correct": false}, {"label": "D", "text": "Pulmonary Artery", "correct": false}], "correct_answer": "B. Umbilical artery", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/CMZpxzz0lttu0BukBZwn1745414537.png"], "explanation": "<p>Correct Answer B - &lt;span class=\"customMeta\" data-dictid=\"9cc3973459169277720194a0847477\"&gt;Umbilical&lt;/span&gt; artery</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Structure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Number</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Type of Blood</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Flow of blood</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Umbilical Artery</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Deoxygenated blood</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Fetus to the placenta</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Umbilical Vein</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Oxygenated blood</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Placenta to the fetus</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following investigations would be most beneficial in diagnosing the condition of a 10-year-old boy who is experiencing seizures along with a medical history of fever accompanied by a rash at the age of 1 year, which was resolved on its own?", "options": [{"label": "A", "text": "lgG measles in CSF", "correct": true}, {"label": "B", "text": "MRI mesial temporal lobe sclerosis", "correct": false}, {"label": "C", "text": "IgM measles in CSF", "correct": false}, {"label": "D", "text": "C1Q4 antibodies in the CSF", "correct": false}], "correct_answer": "A. lgG measles in CSF", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - lgG &lt;span class=\"customMeta\" data-dictid=\"7d2dc6a6df1692777192ccc6fd72b7\"&gt;measles&lt;/span&gt; in CSF:</p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Vaccine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>MR (Measles-Rubella)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Live attenuated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>0.5 ml</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Site</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Right upper arm (at the <span class=\"customMeta\" data-dictid=\"c88a7c1a0116927771909b2463968d\">insertion</span> of deltoid)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Schedule</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1st dose - 9 months; 2nd dose - 16-24 months</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 16-month-old boy weighs 8 kg. A WHO growth chart (weight-for-age) is provided below. What is the most appropriate advice for this child?", "options": [{"label": "A", "text": "No malnutrition - assure the mother", "correct": false}, {"label": "B", "text": "Mild malnutrition - home treatment", "correct": false}, {"label": "C", "text": "Severe malnutrition - refer to nutrition rehabilitation centre", "correct": false}, {"label": "D", "text": "Moderate malnutrition - teach the mother how to feed", "correct": true}], "correct_answer": "D. Moderate malnutrition - teach the mother how to feed", "question_images": ["https://image.prepladder.com/notes/SFiOmwC3lSDEt1D6KNOf1746446435.png"], "explanation_images": ["https://image.prepladder.com/notes/aHq430p05emiLzUoeNwT1746446460.png"], "explanation": "<p>Correct Answer D - Moderate &lt;span class=\"customMeta\" data-dictid=\"cbd2d1fd521692777191d00c1a4ede\"&gt;malnutrition&lt;/span&gt; - teach the mother how to feed</p>\n<p><strong>References:</strong></p>\n<ul><li>↳ Designed specifically to track the growth and development of children under 5 years of age globally.</li><li>↳ under 5 years of age</li><li>↳ Growth charts are derived from the Multicentre Growth Reference Study (MGRS) carried out by the WHO. This study was a community-based, multi-country initiative that took place in Brazil, Ghana, India, Norway, Oman, and the United States.</li><li>↳ Multicentre Growth Reference Study (MGRS)</li><li>↳ Features: Provide accurate references for weight, length, and head circumference, reflecting normal growth patterns in children.</li><li>↳ Percentile Curves : The growth chart displays curves representing percentiles (3rd, 15th, 50th, 85th, and 97th).</li><li>↳ Percentile Curves</li><li>↳ 3rd Percentile: Lower end of normal growth. 50th Percentile: Median or average growth. 97th Percentile: Higher end of normal growth.</li><li>↳ 3rd Percentile: Lower end of normal growth.</li><li>↳ 3rd Percentile:</li><li>↳ 50th Percentile: Median or average growth.</li><li>↳ 50th Percentile:</li><li>↳ 97th Percentile: Higher end of normal growth.</li><li>↳ 97th Percentile:</li></u\n<p><strong>References:</strong></p>\n<ul><li>↳ Normal: Between -2 SD and +2 SD Mild malnutrition: Between -2 SD and -1SD Moderate malnutrition: Between -3 SD and -2 SD Severe malnutrition: Below -3 SD</li><li>↳ Normal: Between -2 SD and +2 SD</li><li>↳ Normal:</li><li>↳ Mild malnutrition: Between -2 SD and -1SD</li><li>↳ Mild malnutrition:</li><li>↳ Moderate malnutrition: Between -3 SD and -2 SD</li><li>↳ Moderate malnutrition:</li><li>↳ Severe malnutrition: Below -3 SD</li><li>↳ Severe malnutrition:</li></u\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable diagnosis for a 7-year-old patient who presented with a white pupillary reflex and underwent enucleation, with histopathological examination revealing the presence of Flexner Wintersteiner rosettes?", "options": [{"label": "A", "text": "Retinoblastoma", "correct": true}, {"label": "B", "text": "Medulloblastoma", "correct": false}, {"label": "C", "text": "Rhabdomyosarcoma", "correct": false}, {"label": "D", "text": "Astrocytoma", "correct": false}], "correct_answer": "A. Retinoblastoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/T604PqLUcKQdVQKY4Cnq1745415673.png", "https://image.prepladder.com/content/L6ZIS7FdNPqEplgQHe8J1745415722.png"], "explanation": "<p>Correct Answer A - Retinoblastoma</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li><strong>Leukocoria</strong> (60%)</li>\n<li><strong>Strabismus</strong> (20%)</li>\n<li>Painful red eye (7%)</li>\n<li>Poor vision (5%)</li>\n<li>Asymptomatic (3%)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fundus Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>White, elevated mass in the retina</li>\n<li>Can be endophytic, exophytic, or mixed growth</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>CT scan: <span class=\"customMeta\" data-dictid=\"a1ee14c673169277718351bfe6afd4\">Calcification</span> in 90% of cases</li>\n<li>MRI: Better for evaluating <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> nerve and <span class=\"customMeta\" data-dictid=\"7d57c304c01692777187da125d18d8\">extraocular</span> extension</li>\n<li>Ultrasound: Useful for initial screening</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histopathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Flexner-Wintersteiner rosettes (highly specific): </strong>These are composed of an ‘empty’ <span class=\"customMeta\" data-dictid=\"e87def492e1692777191eda63cfc5e\">lumen</span> surrounded by columnar cells</li>\n<li><strong>Homer-Wright rosettes: </strong>These are pseudo-rosettes and consist of cells surrounding a central <span class=\"customMeta\" data-dictid=\"e87def492e1692777191eda63cfc5e\">lumen</span> made up of their processes</li>\n<li>Undifferentiated tumor cells</li>\n<li>Areas of <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> and calcification</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Genetic Testing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>RB1 gene</strong> <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> on <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> <strong>13q14</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An industrial worker was admitted to the hospital after an eye injury sustained while cutting stone with a hammer and iron chisel. A foreign body was suspected to be impacted in his eye. Which investigation can be detrimental to this patient?", "options": [{"label": "A", "text": "B mode scan", "correct": false}, {"label": "B", "text": "CT", "correct": false}, {"label": "C", "text": "X-ray", "correct": false}, {"label": "D", "text": "MRI", "correct": true}], "correct_answer": "D. MRI", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - MRI</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>An IOFB is a foreign object that penetrates the eye and remains lodged inside. It is a serious injury that can result in permanent vision loss.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common Types of IOFBs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Metallic (90% of cases): Iron, steel.</li>\n<li>Others: Glass, stone, lead pellets, copper, aluminium, plastic, wood.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Foreign Body Reactions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Inorganic Materials: </strong>Glass, plastic are inert; lead, aluminium, <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> cause <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> responses.</li>\n<li><strong>Organic Materials: </strong>Wood causes <strong>giant cell reactions</strong> and <strong>granulomatous inflammation</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Detailed History: Understand injury mechanism for IOFB type.</li>\n<li><strong>Ocular Examination:</strong>\n<ul>\n<li>Slit-lamp examination</li>\n<li>Gonioscopy</li>\n<li>Ophthalmoscopy (back of the eye)</li>\n</ul>\n</li>\n<li><strong>Signs:</strong>\n<ul>\n<li>Subconjunctival hemorrhage</li>\n<li>Corneal scars/ <span class=\"customMeta\" data-dictid=\"6e53fc929616927771900fbab3617f\">Iris</span> holes</li>\n<li>Opaque tracks in the lens/ IOFB in <span class=\"customMeta\" data-dictid=\"636ccb4336169277720289af6a0778\">vitreous</span> or retina</li>\n</ul>\n</li>\n<li><strong>Investigations:</strong>\n<ul>\n<li>X-rays: Less common; CT is preferred.</li>\n<li>Ultrasonography: B-mode USG locates both <span class=\"customMeta\" data-dictid=\"76584c702f1692777197ee90a74461\">radiopaque</span> and non-radiopaque IOFBs.</li>\n<li><strong>CT Scan:</strong> <strong> Investigation of choice/ Gold standard</strong> for detailed cross-sectional images.</li>\n<li><strong>MRI: Contra-indicated in case of metal foreign bodies (Option D)</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>IOFB Removal: Essential except for inert, <span class=\"customMeta\" data-dictid=\"fc3d080799169277719904701c07f9\">sterile</span> IOFBs not affecting vision or if removal is too risky.\n\t\t\t\t<ul>\n<li>Magnetic IOFBs: Removed using a handheld electromagnet.</li>\n<li>Non-magnetic IOFBs: Requires specialized procedures.</li>\n</ul>\n</li>\n<li><strong>Removal Methods:</strong>\n<ul>\n<li><strong>Anterior Chamber:</strong>\n<ul>\n<li>Corneal incision, avoiding central cornea.</li>\n<li>Magnetic IOFBs: Handheld magnet.</li>\n<li>Non-magnetic IOFBs: Specialized forceps.</li>\n</ul>\n</li>\n<li><strong>Iris: </strong>Sector <span class=\"customMeta\" data-dictid=\"744b697ac31692777190fa2c638b3a\">iridectomy</span> for IOFBs in the iris.</li>\n<li><strong>Lens:</strong> <span class=\"customMeta\" data-dictid=\"ab0f3917ce1692777187309ec78709\">Extracapsular</span> <span class=\"customMeta\" data-dictid=\"781e6a5a991692777183252720baad\">cataract</span> <span class=\"customMeta\" data-dictid=\"00456bf7d8169277718782edf9fa2c\">extraction</span> <strong>(ECCE)</strong> with or without lens removal.</li>\n<li><strong>Vitreous and Retina: <span class=\"customMeta\" data-dictid=\"4bc4237fe3169277719497604c0f00\">Pars</span> <span class=\"customMeta\" data-dictid=\"2d0756b0d11692777195ef3bcd110d\">plana</span> vitrectomy</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Post-Removal Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Topical/systemic antibiotics for infection prevention.</li>\n<li>Topical corticosteroids to reduce inflammation.</li>\n<li>Cycloplegic agents (e.g., atropine) for <span class=\"customMeta\" data-dictid=\"e419fd4e241692777196d038d1b71a\">pupil</span> <span class=\"customMeta\" data-dictid=\"d141b433d2169277718681e3ff6bc3\">dilation</span> and pain relief.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which nerve is most likely to be affected in a patient who underwent a coronary bypass graft with the great saphenous vein and is now experiencing paresthesia and sensory loss over the inner side of the leg and foot?", "options": [{"label": "A", "text": "Superficial peroneal nerve", "correct": false}, {"label": "B", "text": "Saphenous nerve", "correct": true}, {"label": "C", "text": "Femoral nerve", "correct": false}, {"label": "D", "text": "Sural nerve", "correct": false}], "correct_answer": "B. Saphenous nerve", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented with vision loss. On radiological investigation, an aneurysm causing damage to the optic chiasma was noted. Which of the following arteries is most likely to be the artery that is causing the damage?", "options": [{"label": "A", "text": "Anterior communicating artery", "correct": true}, {"label": "B", "text": "Anterior choroidal artery", "correct": false}, {"label": "C", "text": "Middle cerebral artery", "correct": false}, {"label": "D", "text": "Anterior cerebral artery", "correct": false}], "correct_answer": "A. Anterior communicating artery", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/CLltIBDSWORNEoQtbGtI1746447005.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 34-year-old man presented with a fever and massive splenomegaly. The spleen was 15 cm on palpation and directed obliquely when measured from the right iliac fossa. Which of the following structures prevent the vertical and downward descent of the spleen?", "options": [{"label": "A", "text": "Lienorenal ligament", "correct": false}, {"label": "B", "text": "Gastrosplenic ligament", "correct": false}, {"label": "C", "text": "Phrenicocolic ligament", "correct": true}, {"label": "D", "text": "Lienophrenic ligament", "correct": false}], "correct_answer": "C. Phrenicocolic ligament", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - &lt;span class=\"customMeta\" data-dictid=\"bbe136d7de1692777195b3f4e371c6\"&gt;Phrenicocolic&lt;/span&gt; lig\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the papillae from the given histological section?", "options": [{"label": "A", "text": "Fungiform", "correct": false}, {"label": "B", "text": "Circumvallate", "correct": true}, {"label": "C", "text": "Filiform", "correct": false}, {"label": "D", "text": "Foliate", "correct": false}], "correct_answer": "B. Circumvallate", "question_images": ["https://image.prepladder.com/notes/hXuB9JadqCr9x7xAAMqZ1746447820.png"], "explanation_images": [], "explanation": "<p>Correct Answer B - Circumv\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 7-year-old boy was brought to the hospital with multiple fractures of the humerus secondary to a fall from height. On examination, there is difficulty in flexion of the elbow and supination of the forearm and associated loss of sensation over the lateral aspect of the forearm. Which is the nerve most likely to be injured?", "options": [{"label": "A", "text": "Median nerve", "correct": false}, {"label": "B", "text": "Radial nerve", "correct": false}, {"label": "C", "text": "Musculocutaneous nerve", "correct": true}, {"label": "D", "text": "Ulnar nerve", "correct": false}], "correct_answer": "C. Musculocutaneous nerve", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ZmYl529UXxCWVzTHp6oK1745417028.png", "https://image.prepladder.com/content/6qaqjOVuqxkPZY8T97Jh1745417073.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Muscle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Attachments</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Nerve supply</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Action</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Biceps brachii</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Origin:</strong> <strong>Short head-</strong> <span class=\"customMeta\" data-dictid=\"6d706ad0a916927771852098e31258\">Coracoid</span> process ; <strong>Long head-</strong> Supragelnoid tubercle</li>\n<li><strong>Insertion:</strong> Radial tuberosity</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Musculocutaneous nerve <strong>(C5-C6)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Flexion and supination</strong> of forearm</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Brachialis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Origin:</strong> <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> humerus</li>\n<li><strong>Insertion:</strong> <span class=\"customMeta\" data-dictid=\"2d0cdf9e0e1692777185d4b709e843\">coronoid</span> process &amp; <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> tuberosity</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Motor:</strong> <span class=\"customMeta\" data-dictid=\"e5f2019ed01692777193cd7024068f\">Musculocutaneous</span> nerve</li>\n<li><strong>Proprioceptive:</strong> Radial nerve</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Flexion of forearm</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Coraco- brachialis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Origin:</strong> <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> <span class=\"customMeta\" data-dictid=\"6d706ad0a916927771852098e31258\">coracoid</span> process</li>\n<li><strong>Insertion:</strong> <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> aspect of middle humerus</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Musculocutaneous nerve</strong> <strong>(C5-C7)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Flexion of arm</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented with jaw swelling and weight loss. Suspecting a malignancy, the submandibular gland was resected. Which is the most likely nerve to be damaged during submandibular gland resection?", "options": [{"label": "A", "text": "Nerve to mylohyoid", "correct": false}, {"label": "B", "text": "Inferior alveolar nerve", "correct": false}, {"label": "C", "text": "Lingual nerve", "correct": true}, {"label": "D", "text": "Hypoglossal nerve", "correct": false}], "correct_answer": "C. Lingual nerve", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/usoxd9Liyu5SnnKSs5T51746448117.png"], "explanation": "<p>Correct Answer C - &lt;span class=\"customMeta\" data-dictid=\"f7c3ba6f1c1692777191e58e8571b0\"&gt;Lingual&lt;/span&gt; nerv\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During the clinical examination of the nervous system, which of the following nerves can be tested by touching the highlighted structure?", "options": [{"label": "A", "text": "IX", "correct": true}, {"label": "B", "text": "X", "correct": false}, {"label": "C", "text": "XI", "correct": false}, {"label": "D", "text": "XII", "correct": false}], "correct_answer": "A. IX", "question_images": ["https://image.prepladder.com/notes/IewviWJd4GYn9UXukD2h1746448273.png"], "explanation_images": [], "explanation": "<p>Correct Answer A - IX\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient on aspirin presented with occult blood in the stool. This occurs due to the inhibition of ________ by aspirin.", "options": [{"label": "A", "text": "Phospholipase A2", "correct": false}, {"label": "B", "text": "Thromboxane", "correct": true}, {"label": "C", "text": "Phospholipase C", "correct": false}, {"label": "D", "text": "Phospholipase D", "correct": false}], "correct_answer": "B. Thromboxane", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Aspirin</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>MOA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inhibits <span class=\"customMeta\" data-dictid=\"ebd6f6186316927771854d3b6d65be\">cyclooxygenase</span> (COX) enzymes, particularly COX-1 and COX-2. COX-1 is involved in the production of prostaglandins and<strong> thromboxane.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Effect on platelets </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Thromboxane A2 is a potent pro-inflammatory and pro-thrombotic molecule that promotes <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">platelet</span> <span class=\"customMeta\" data-dictid=\"a00e90be0416927771803afbbf099b\">aggregation</span> and vasoconstriction.</li>\n<li>By inhibiting COX-1, <span class=\"customMeta\" data-dictid=\"deba671f4716927771828c95a320e5\">aspirin</span> reduces the production of <span class=\"customMeta\" data-dictid=\"96309dcb1c169277720072ad555473\">thromboxane</span> A2, which leads to decreased <span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\">platelet</span> <span class=\"customMeta\" data-dictid=\"a00e90be0416927771803afbbf099b\">aggregation</span> and a <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> tendency for <span class=\"customMeta\" data-dictid=\"40d68b98721692777183c42090e023\">blood clot</span> formation, which can contribute to <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> bleeding, including the presence of <span class=\"customMeta\" data-dictid=\"c8d9b6cbbb1692777194c4bc31f01f\">occult</span> blood in the stool.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Uses </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Analgesic: <span class=\"customMeta\" data-dictid=\"40dbde72e41692777197e59d893839\">Rheumatoid</span> arthritis</li>\n<li>Antipyretic</li>\n<li>Antiplatelet: Post Myocardial <span class=\"customMeta\" data-dictid=\"657b33591e16927771902ea85cfde8\">infraction</span> and CVA</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Adverse effects </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>0.5-2 g/day - <span class=\"customMeta\" data-dictid=\"fe706b145216927771819c62504cd8\">analgesic</span> dose</strong></p>\n<ul>\n<li>Nausea and vomiting</li>\n<li>Epigastric discomfort</li>\n</ul>\n<p><strong>3-5 g/day - anti-inflammatory dose</strong></p>\n<ul>\n<li>Salicylism - vertigo, hyperventilation, tinnitus, <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">reversible</span> loss of hearing</li>\n<li>Hepatitis</li>\n<li>Hypersensitivity</li>\n</ul>\n<p><strong>Reye’s syndrome</strong>: A rare condition seen when salicylates are given in children suffering from <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> infections such as influenza, presenting as <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> liver failure.</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old postmenopausal female patient with a previous history of Colle’s fracture came to the OPD with complaints of lower backache. On evaluation, her T score was -2.5. Which of the following statements about the management of her condition are false?", "options": [{"label": "A", "text": "Teriparatide should be started before supplementing with bisphosphonates", "correct": false}, {"label": "B", "text": "Bisphosphonates are not given for more than a year", "correct": true}, {"label": "C", "text": "Calcium requirement is 1200 mg per day", "correct": false}, {"label": "D", "text": "Oral vitamin D3 is given along with oral calcium", "correct": false}], "correct_answer": "B. Bisphosphonates are not given for more than a year", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/Am4TZ434WQ1WAjPfDjII1746448469.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:588px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Role of Bisphosphonates</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Osteoporosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Effective in preventing and treating <span class=\"customMeta\" data-dictid=\"c9ba8fa63616927771962d84263e40\">postmenopausal</span> osteoporosis, age-related, idiopathic, and steroid-induced osteoporosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Paget's Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Arrest osteolytic lesions, reduce bone pain, and improve secondary symptoms.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hypercalcemia of Malignancy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lower <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> levels, especially in severe cases.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Metastatic Bone Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Arrest osteolytic lesions and reduce bone pain.</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:633px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Pharmacological Agents</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mechanism of Action</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Bisphosphonates </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Interfere with <strong>osteoclast</strong> activity, leading to decreased bone resorption.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Calcitonin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inhibits <strong>osteoclast</strong> activity, reducing bone resorption.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Denosumab</strong> <strong> </strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It inhibits the RANK ligand, which is essential for <strong>osteoclast </strong>formation and function.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Estrogen/Raloxifene</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inhibit <strong>osteoclast</strong> activity and slow bone loss.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cinacalcet</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Indirectly reduces <span class=\"customMeta\" data-dictid=\"17d9369c3f1692777183b01f1dc72f\">bone resorption</span> by <strong>lowering <span class=\"customMeta\" data-dictid=\"5eff25235516927771968c590529d7\">PTH</span> levels</strong>.(by stimulating CaSR receptors)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Teriparatide</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A <span class=\"customMeta\" data-dictid=\"b566321fe8169277719716b1cf4df0\">recombinant</span> <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of <span class=\"customMeta\" data-dictid=\"5eff25235516927771968c590529d7\">PTH</span> stimulates <strong>osteoblast </strong>activity.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Strontium Ranelate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dual action:</strong> It promotes bone formation by stimulating <strong>osteoblasts </strong>and decreases <span class=\"customMeta\" data-dictid=\"17d9369c3f1692777183b01f1dc72f\">bone resorption</span> by inhibiting <strong>osteoclast</strong> activity.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Calcium and vitamin D</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It suppresses <span class=\"customMeta\" data-dictid=\"259c7d2f221692777183ec47febc61\">bone turnover</span> and improves bone mineral density</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old man presented with excessive fatiguability towards the end of the day that improved with rest. He also gives a history of ptosis and difficulty in speech and swallowing. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Myasthenia gravis", "correct": true}, {"label": "B", "text": "Lambert-Eaton syndrome", "correct": false}, {"label": "C", "text": "Duchenne muscular dystrophy", "correct": false}, {"label": "D", "text": "Systemic lupus erythematosus", "correct": false}], "correct_answer": "A. Myasthenia gravis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Affected Muscles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Key Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ocular muscles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mimics central eye movement disorders.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cogan's lid <span class=\"customMeta\" data-dictid=\"4f7448b3e51692777201ff5cafde0d\">twitch</span> sign</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>The upper <span class=\"customMeta\" data-dictid=\"819ddea9e51692777187cdff06b437\">eyelid</span> rises briefly after looking down for some time.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Shoulder <span class=\"customMeta\" data-dictid=\"a1d37a92d41692777188e12a817797\">girdle</span> muscles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Difficulty in overhead activities like combing hair.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Respiratory muscles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weakness may cause <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> failure and <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> risks.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented with a history of multiple episodes of vomiting. He was given intravenous medication for the same. Later, he developed abnormal movements. Which of the following drugs can be used to treat him?", "options": [{"label": "A", "text": "Hyoscine", "correct": false}, {"label": "B", "text": "Cyprohepptadine", "correct": false}, {"label": "C", "text": "Levodopa", "correct": false}, {"label": "D", "text": "Benzhexol", "correct": true}], "correct_answer": "D. Benzhexol", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:689px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Metoclopramide</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>MOA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Dopamine <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antagonist; acts centrally as a <span class=\"customMeta\" data-dictid=\"61274f971e1692777196235af20217\">prokinetic</span> and anti-emetic.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Side effects </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Extrapyramidal symptoms </strong>\n<ul>\n<li>Acute <span class=\"customMeta\" data-dictid=\"61747121f116927771862fad303b93\">dystonia</span> - occurs shortly after IV injection</li>\n<li>Parkinson-like symptoms seen after weeks of therapy</li>\n<li>Irreversible <span class=\"customMeta\" data-dictid=\"d93ab38f5316927772001828e5e817\">tardive</span> <span class=\"customMeta\" data-dictid=\"aa971a0b1c169277718621174b6657\">dyskinesia</span> - occurs with chronic treatment</li>\n</ul>\n</li>\n<li>Galactorrhoea</li>\n<li>Methemoglobinemia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management of <span class=\"customMeta\" data-dictid=\"e2952dfc311692777187fa773bcc9f\">extrapyramidal</span> symptoms </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Discontinuation of the drug.</li>\n<li><strong>Benzhexol</strong> - centrally acting <span class=\"customMeta\" data-dictid=\"9b4dbbb3321692777181e6fe172b88\">anticholinergic</span> agents.</li>\n<li>Restores <span class=\"customMeta\" data-dictid=\"8656dac49a16927771846b41f8cf19\">cholinergic</span> balance in the <span class=\"customMeta\" data-dictid=\"10dcc5831f169277719904802d9cad\">striatal</span> interneurons.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the dosing rate of a drug based on?", "options": [{"label": "A", "text": "Clearance / desired peak plasma concentration", "correct": false}, {"label": "B", "text": "Clearance of drug X desired peak plasma concentration", "correct": true}, {"label": "C", "text": "Clearance X loading dose", "correct": false}, {"label": "D", "text": "Clearance/loading dose", "correct": false}], "correct_answer": "B. Clearance of drug X desired peak plasma concentration", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\">Steady-state concentration = dosing rate/clearance</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Loading dose = <span class=\"customMeta\" data-dictid=\"ee6800538c169277720292cf2d4f1c\">Volume of distribution</span> X Desired steady-state <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> concentration</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Maintenance dose = Target <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> concentration X <span class=\"customMeta\" data-dictid=\"3a3fb1b8a816927771840e6a344cc0\">Clearance</span> X Dosing interval</p>\n<p style=\"text-align: center;\">Bioavailability (F)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Dosing rate = <span class=\"customMeta\" data-dictid=\"3a3fb1b8a816927771840e6a344cc0\">Clearance</span> of drug X desired peak <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> concentration</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 68-year-old man presents with a cough with yellowish sputum. Auscultation revealed bronchial breath sounds. He is hemodynamically stable and not confused. On examination, his respiratory rate is 20/min, and his blood pressure is 110/70 mmHg. Lab reports show urea levels of 44 mg/dL. What is the next best step in the management of this patient?", "options": [{"label": "A", "text": "Given antibiotics and send the patient home", "correct": false}, {"label": "B", "text": "Admit to ICU without mechanical ventilation", "correct": false}, {"label": "C", "text": "Admit to ICU with invasive mechanical ventilation", "correct": false}, {"label": "D", "text": "Consider admission in a non-ICU setting", "correct": true}], "correct_answer": "D. Consider admission in a non-ICU setting", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>CURB-65</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Symptom</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Score</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>(<strong>C</strong>) Confusion</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>(<strong>U</strong>) Urea: <span class=\"customMeta\" data-dictid=\"eeb0ec7e661692777183f957a8794b\">BUN</span> &gt;19mg/dL (&gt;7 mmol/L)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>(<strong>R</strong>) <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> rate ≥30/min</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>(<strong>B</strong>) <span class=\"customMeta\" data-dictid=\"263ee5444e1692777183a7e8e704da\">Blood Pressure</span> – <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">Systolic</span> BP ≤90 mmHg or diastolic BP ≤60 mmHg</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>(<strong>65</strong>) Age ≥65 years</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">1</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with chronic kidney disease underwent a nephrectomy. Which of the following can be administered as a postoperative analgesic in this patient?", "options": [{"label": "A", "text": "Naproxen", "correct": false}, {"label": "B", "text": "Indomethacin", "correct": false}, {"label": "C", "text": "Diclofenac", "correct": false}, {"label": "D", "text": "Acetaminophen", "correct": true}], "correct_answer": "D. Acetaminophen", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which anti-hypertensive medication is suitable for administration to a patient suffering from renal insufficiency, exhibiting symptoms of significantly reduced urine output, pedal edema, headache, and a blood pressure reading of 160/90?", "options": [{"label": "A", "text": "Aliskiren", "correct": false}, {"label": "B", "text": "Chlorthalidone", "correct": false}, {"label": "C", "text": "Amlodipine", "correct": true}, {"label": "D", "text": "Prazosin", "correct": false}], "correct_answer": "C. Amlodipine", "question_images": [], "explanation_images": [], "explanation": "<table align=\"left\" cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Drug</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Use</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Rationale for Choice</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Nifedipine </strong></p>\n<p>(Short-acting)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Primarily used for<strong> <span class=\"customMeta\" data-dictid=\"030cd51b341692777181d15302c8d4\">angina</span> pectoris.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is not recommended for long-term <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> management due to its <strong>short duration of action</strong> and potential for <strong>reflex tachycardia</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Nicardipine</strong></p>\n<p>(Short-acting)</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is commonly used in the management of <strong>hypertensive emergencies </strong>and <strong>perioperative hypertension</strong> or severe <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> in the <span class=\"customMeta\" data-dictid=\"901bf573f216927771905f0abedca2\">intensive</span> care unit.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The short duration of action makes it less suitable for long-term <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> management.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clevidipine</strong></p>\n<p>(Ultra-short-acting)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Very short half-life</strong> makes it unsuitable for long-term <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">hypertension</span> management.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Amlodipine</strong></p>\n<p>(Long-acting)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Recommended as a first-line or add-on therapy for the<strong> long-term management of hypertension.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Preferred choice due to its long duration of action (up to 24 hours), once-daily dosing, and effectiveness in <span class=\"customMeta\" data-dictid=\"ff02aa40d51692777191246d4a9b87\">lowering</span> <span class=\"customMeta\" data-dictid=\"263ee5444e1692777183a7e8e704da\">blood pressure</span> with good tolerability.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A chronic alcoholic male patient presented with abdominal distension, reduced urine output, and pedal oedema. His serum creatinine was 1.6 mg/dL. What is the next line of management for this patient?", "options": [{"label": "A", "text": "Methylprednisolone", "correct": false}, {"label": "B", "text": "Heparin", "correct": false}, {"label": "C", "text": "Torsemide", "correct": false}, {"label": "D", "text": "Octreotide plus albumin", "correct": true}], "correct_answer": "D. Octreotide plus albumin", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment of <span class=\"customMeta\" data-dictid=\"9d718b233816927771881fe77e3390\">Hepatorenal</span> syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Discontinue diuretics</li>\n<li>Albumin infusion- 1 g/kg per day</li>\n<li>Vasoconstrictors-Terlipressin, Low-dose Norepinephrine</li>\n<li>Midodrine (an α-agonist), along with<strong> <span class=\"customMeta\" data-dictid=\"e705e1d6aa1692777194f6571628c6\">octreotide</span> and <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> albumin</strong></li>\n<li>The best therapy for <span class=\"customMeta\" data-dictid=\"136c4bdd441692777189c5b2e976a0\">HRS</span> is liver transplantation; recovery of <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> function is typical in this setting</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Evaluation of a patient revealed the presence of a mid-diastolic murmur. JVP showed prominent a-waves. What is the likely diagnosis?", "options": [{"label": "A", "text": "Mitral stenosis", "correct": false}, {"label": "B", "text": "Tricuspid stenosis", "correct": true}, {"label": "C", "text": "Mitral regurgitation", "correct": false}, {"label": "D", "text": "Tricuspid regurgitation", "correct": false}], "correct_answer": "B. Tricuspid stenosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/PkEPp5NqgWeTqUnC3FpD1746448816.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Tricuspid Stenosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Aetiology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Congenital</li>\n<li>Rheumatic origin (often coexists with <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> stenosis)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>RA pressure <strong>↑ , </strong>due to the <span class=\"customMeta\" data-dictid=\"a44fd2b1e71692777186a33144c6ad\">diastolic pressure</span> <span class=\"customMeta\" data-dictid=\"04136f692516927771888cf07d46a4\">gradient</span> between RA and RV, results in <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> congestion.</li>\n<li>Restricted forward flow of blood leads to <strong>↓ </strong>cardiac output.</li>\n</ul>\n<p style=\"text-align: center;\"><img alt=\"Pathophysiology of TS\" data-author=\"\" data-hash=\"12031\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" height=\"400\" src=\"https://image.prepladder.com/notes/PkEPp5NqgWeTqUnC3FpD1746448816.png\" width=\"400\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Fatigue</li>\n<li>Mild dyspnea</li>\n<li>Venous <span class=\"customMeta\" data-dictid=\"2dd9736fdf16927771849f5a925f7d\">congestion</span> (right-side heart failure): Hepatomegaly, ascites, oedema and may lead to <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> cirrhosis.</li>\n<li>Physical examination:\n\t\t\t\t<ul>\n<li>Jugular <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> distension with <strong>prominent ‘a’ waves</strong></li>\n<li>Auscultation: <strong>Mid-diastolic murmur</strong> at left lower sternal border</li>\n<li><strong>Murmur increases with inspiration </strong><strong>(Carvallo's sign).</strong></li>\n</ul>\n</li>\n<li>If <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">stenosis</span> coexist\n\t\t\t\t<ul>\n<li>Pulmonary <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> hypertension</li>\n<li>Orthopnea due to <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> oedema</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Investigations </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Chest X-ray</strong> and <strong>ECG </strong>show features of RA enlargement</li>\n<li><strong>Echocardiogram: </strong>Thickened <span class=\"customMeta\" data-dictid=\"3ab13cdf64169277720085e2ebef1c\">tricuspid</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> with diastolic doming and increased pressure <span class=\"customMeta\" data-dictid=\"04136f692516927771888cf07d46a4\">gradient</span> between RV and RA.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Medical management: </strong>To reduce <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> <span class=\"customMeta\" data-dictid=\"2dd9736fdf16927771849f5a925f7d\">congestion</span> symptoms\n\t\t\t\t<ul>\n<li>Dietary salt restriction</li>\n<li>Loop diuretics</li>\n</ul>\n</li>\n<li><strong>Surgical intervention: </strong>Valvular repair or <span class=\"customMeta\" data-dictid=\"c936e2cd131692777196b1d877f678\">Prosthetic</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> replacement.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 70-year-old female patient presents with pain in the thigh during walking. Investigation reveals the following finding as given below. What will be the best surgical management?", "options": [{"label": "A", "text": "PTA with stenting", "correct": false}, {"label": "B", "text": "Femoroiliac bypass", "correct": false}, {"label": "C", "text": "Aortofemoral bypass", "correct": true}, {"label": "D", "text": "Aorto-iliac bypass", "correct": false}], "correct_answer": "C. Aortofemoral bypass", "question_images": ["https://image.prepladder.com/notes/TmUYX8H4e9TQc2SqIJes1746448949.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 20-year-old woman presents with breathlessness and chest pain. She is a known case of mitral stenosis. Her pulse is irregularly irregular. No thrombus is seen on echocardiography. What is the best agent to prevent future thrombotic events?", "options": [{"label": "A", "text": "Dabigatran", "correct": false}, {"label": "B", "text": "Aspirin 150mg", "correct": false}, {"label": "C", "text": "Oral warfarin", "correct": true}, {"label": "D", "text": "Aspirin + Clopidogrel", "correct": false}], "correct_answer": "C. Oral warfarin", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is true regarding the condition mentioned below?", "options": [{"label": "A", "text": "Patient must be started on anti-gas gangrene serum therapy", "correct": false}, {"label": "B", "text": "It is a mixed flora aerobic and anaerobic infection", "correct": true}, {"label": "C", "text": "Bilateral orchiectomy is generally performed", "correct": false}, {"label": "D", "text": "Compulsory urinary diversion is performed", "correct": false}], "correct_answer": "B. It is a mixed flora aerobic and anaerobic infection", "question_images": ["https://image.prepladder.com/notes/jDvw1guqwK3KI7ANEt8K1746449301.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:616px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Necrotizing infection of the soft tissues in the perineum, external genitalia, and <span class=\"customMeta\" data-dictid=\"fb89fe7db116927771957d22da5a71\">perianal</span> region, akin to <span class=\"customMeta\" data-dictid=\"f826a1a46e1692777193319fa1e5ed\">necrotizing</span> fasciitis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is usually caused by mixed bacterial fora (Escherichia coli, Bacteroides spp., Streptococcus pyogenes, Staphylococcus aureus). <strong>(Option B) </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Symptoms: Intense pain in the genitalia, progressing through five phases:\n\t\t\t\t<ul>\n<li>Prodromal Phase: Fever and lethargy.</li>\n<li>Early Pain Phase: Intense pain, possible oedema, pruritus.</li>\n<li>Progressive Phase: Increased pain, and erythema.</li>\n<li>Crepitation Phase: Dusky skin with <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> crepitation.</li>\n<li>Gangrene Phase: <span class=\"customMeta\" data-dictid=\"741c89cb18169277718889cfaafa53\">Gangrene</span> with <span class=\"customMeta\" data-dictid=\"0c02372a7d1692777196974ab1d772\">purulent</span> discharge.</li>\n</ul>\n</li>\n<li>Pain may decrease as <span class=\"customMeta\" data-dictid=\"741c89cb18169277718889cfaafa53\">gangrene</span> progresses.</li>\n<li>Severity ranges from localised <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> to <span class=\"customMeta\" data-dictid=\"39f67d7dde16927771985d3952058d\">septic</span> shock.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Peripheral <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> disease, diabetes mellitus, malnutrition, alcoholism, <span class=\"customMeta\" data-dictid=\"a3cc9f976916927771895692a1a8a0\">immunocompromised</span> states.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Clinical presentation supported by <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> or lab findings.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Initial Treatment:\n\t\t\t\t<ul>\n<li>Fluid resuscitation.</li>\n<li>Broad-spectrum antibiotics.</li>\n<li>Surgical debridement of necrotic tissue.</li>\n</ul>\n</li>\n<li>Additional Measures:\n\t\t\t\t<ul>\n<li>Urinary and fecal <span class=\"customMeta\" data-dictid=\"73224cf5e516927771862db3f8f2f2\">diversion</span> to prevent wound contamination.</li>\n<li>Intensive monitoring for sepsis.</li>\n<li>Wound review and vacuum-assisted dressing.</li>\n<li>Skin <span class=\"customMeta\" data-dictid=\"6ca773c032169277718858b8ad1e9c\">grafting</span> post-infection control.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient underwent cholecystectomy for gallstones 2.5 years ago. She now presents with symptoms of obstructive jaundice. Investigation reveals a stone in the common bile duct. What is the stone most likely to be?", "options": [{"label": "A", "text": "Primary", "correct": false}, {"label": "B", "text": "Secondary", "correct": false}, {"label": "C", "text": "Tertiary", "correct": false}, {"label": "D", "text": "Recurrent", "correct": true}], "correct_answer": "D. Recurrent", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/BvKG7MMRIjOK7w8XBip51746449567.png", "https://image.prepladder.com/content/rXBrSHbDbLrKj1BGQpWI1745472702.png", "https://image.prepladder.com/content/MAPA9k80DGqPBr4c4bA81745472702.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Types </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li><strong>Retained common <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> stones</strong>\n<ul>\n<li>Detected within 2 years of cholecystectomy</li>\n</ul>\n</li>\n<li><strong>Recurrent common <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> stones</strong>\n<ul>\n<li>Detected after 2 years of <span class=\"customMeta\" data-dictid=\"ca4c1c8d6216927771848e90a15c74\">cholecystectomy</span> <strong>(Option D)</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Charcot’s <span class=\"customMeta\" data-dictid=\"1a0a43d74e16927772004473a05ae3\">triad</span> : </strong>Pain + Fever + Jaundice</li>\n<li><strong>Reynauld’s pentad:</strong> Mental status changes + Hypotension + Charcot’s triad</li>\n<li><strong>Biliary colic:</strong> A sudden, severe, colicky pain in the right upper <span class=\"customMeta\" data-dictid=\"3a757d7c1216927771968223be411d\">quadrant</span> that radiates to the back and shoulder, precipitated by a <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> or heavy meal, and can last for a few hours.</li>\n<li>Darkening of the <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> and <span class=\"customMeta\" data-dictid=\"1b795394751692777191dd8d839fe7\">lightening</span> of the stools.</li>\n<li>Steatorrhea, or <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">fatty</span> stools</li>\n<li>Pruritus (itching), loss of appetite, weight loss, nausea, and vomiting</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Ultrasound:</strong> Useful for detecting gallstones and CBD <span class=\"customMeta\" data-dictid=\"d141b433d2169277718681e3ff6bc3\">dilation</span> but has limited sensitivity for CBD stones.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"CBD -USG\" data-author=\"Cerevisae\" data-hash=\"12041\" data-license=\"CC BY-SA 4.0\" data-source=\"File:Ultrasound of stone within the distal common bile duct.jpg - Wikimedia Commons\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/BvKG7MMRIjOK7w8XBip51746449567.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>MRCP:</strong> Non-invasive, excellent for visualising <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> tree <span class=\"customMeta\" data-dictid=\"9e99effc421692777181b02606e021\">anatomy</span> and pathology.</li>\n<li><strong>ERCP:</strong> Highly sensitive, both <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> and <span class=\"customMeta\" data-dictid=\"8dfaeedbf91692777200561b2b1d2f\">therapeutic</span> for CBD stones.</li>\n<li><strong>PTC:</strong> Used when ERCP is not feasible, such as post-gastrectomy patients or unsuccessful ERCP attempts.</li>\n<li><strong>EUS:</strong> <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">Invasive</span> but accurate for diagnosing choledocholithiasis.</li>\n<li><strong>Blood Tests:</strong> ↑ bilirubin, ↑alkaline phosphatase, and ↑white <span class=\"customMeta\" data-dictid=\"54dd4915601692777183af673aaf7b\">blood cell count</span> indicate <span class=\"customMeta\" data-dictid=\"92128a6d941692777184f9d2f7ef4d\">choledocholithiasis</span> and possible complications like cholangitis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Endoscopic Management:</strong> ERCP with <span class=\"customMeta\" data-dictid=\"175e83e48b1692777199af3924b28b\">sphincterotomy</span> and stone extraction; stenting if necessary.</li>\n<li><strong>Percutaneous Removal:</strong> Used when <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">endoscopic</span> access is difficult.</li>\n<li><strong>Surgery:</strong> Options include <span class=\"customMeta\" data-dictid=\"b506527af81692777191e0f69912f6\">laparoscopic</span> and open choledocholithotomy, choledochoduodenostomy, and choledochojejunostomy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Cholangitis</li>\n<li>Pancreatitis</li>\n<li>Liver Damage</li>\n<li>Biliary Stricture</li>\n<li>Gallstone Ileus</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a patient with abdominal pain and sterile pyuria, what is the finding shown in the image given?", "options": [{"label": "A", "text": "Putty kidney", "correct": true}, {"label": "B", "text": "Nephrocalcinosis", "correct": false}, {"label": "C", "text": "Staghorn calculus", "correct": false}, {"label": "D", "text": "Psoas calcification", "correct": false}], "correct_answer": "A. Putty kidney", "question_images": ["https://image.prepladder.com/content/kiEI6VDhX5EUgjZcVeUx1745472776.png"], "explanation_images": ["https://image.prepladder.com/content/5gSx6lJ8GQv9zLntFjQz1745472816.png", "https://image.prepladder.com/content/1SM85cDZfbCpKhjICjcX1745472816.png", "https://image.prepladder.com/notes/66FAyySbO1tzSucoNAj41746449857.png", "https://image.prepladder.com/notes/rPrblzaXxEPpLMT2rblj1746449877.png", "https://image.prepladder.com/notes/O6ReSTQJZH3knt0AvHKT1746449899.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable diagnosis for a 25-year-old patient who has been experiencing abdominal pain and fever for the past three days, based on the provided chest X-ray taken in an upright position?", "options": [{"label": "A", "text": "Hollow viscus perforation", "correct": true}, {"label": "B", "text": "Gastric volvulus", "correct": false}, {"label": "C", "text": "Liver abscess", "correct": false}, {"label": "D", "text": "Empyema thoracis", "correct": false}], "correct_answer": "A. Hollow viscus perforation", "question_images": ["https://image.prepladder.com/content/DdPZGGoCRjMfdvhTrAF81745472895.png"], "explanation_images": ["https://image.prepladder.com/content/FxihSQnKDyDteeiKnzv61745472932.png", "https://image.prepladder.com/notes/eS3KhE2TrjtWFtydKgXZ1746450182.png", "https://image.prepladder.com/notes/zeS1uPPFzXGFfycYfk8z1746450207.png", "https://image.prepladder.com/content/2hudY648gbIdKlTMLA321745472932.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "According to the CEAP classification, What will be the stage in this patient as the patient presents with the same problem again and again?", "options": [{"label": "A", "text": "C2", "correct": true}, {"label": "B", "text": "C1", "correct": false}, {"label": "C", "text": "C4a", "correct": false}, {"label": "D", "text": "C5", "correct": false}], "correct_answer": "A. C2", "question_images": ["https://image.prepladder.com/notes/VzDCelp9U3o4wc4JjVvL1746450314.png"], "explanation_images": ["https://image.prepladder.com/notes/1ZUCZCmtfkgYn3uQHfjc1746450590.png", "https://image.prepladder.com/notes/ZvvC9ezAtzNnuoVMqw7Q1746450613.png", "https://image.prepladder.com/notes/8QEMB1r2PaXAKhyWIs3S1746450635.png", "https://image.prepladder.com/notes/0lCvsK707UiUeKEcc7L31746450673.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Classification </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>For<strong> clinical</strong> classification:</p>\n<ul>\n<li>No signs of <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> disease</li>\n<li>Telangiectasia (&lt;1 mm) or <span class=\"customMeta\" data-dictid=\"0b6b1f44cb1692777197afef785626\">reticular</span> veins ( 1-3 mm dilated veins)</li>\n<li>Varicose veins (&gt;3 mm )</li>\n<li><strong>Edema </strong></li>\n<li>Pigmentation or eczema</li>\n<li>LDS or atrophic blanche</li>\n<li>Corona phlebectatica</li>\n<li><strong>Healed <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> <span class=\"customMeta\" data-dictid=\"7b4370a0b01692777201a5bc0739c2\">ulcer</span> </strong></li>\n<li><strong>Active <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> ulcer</strong></li>\n</ul>\n<p> </p>\n<p>Clinical class can be further characterised as <strong>symptomatic </strong>(s), <strong>asymptomatic </strong>(a) or <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> following previous successful treatment or <span class=\"customMeta\" data-dictid=\"9cf83937931692777188a014337dcf\">healing</span> (r), e.g. C2a, C2s, C6r.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>C0</li>\n<li>C1 <strong>(Option B ruled out)</strong></li>\n<li>C2 <strong>(Option A)</strong></li>\n<li><strong>C3</strong></li>\n<li>C4a <strong>(Option C ruled out)</strong></li>\n<li>C4b</li>\n<li>C4c</li>\n<li><strong>C5 (Option D ruled out)</strong></li>\n<li><strong>C6</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>For <strong>etiological</strong> classification:</p>\n<ul>\n<li>Congenital</li>\n<li>Primary</li>\n<li>Secondary (post-thrombotic)</li>\n<li>No <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> cause identified</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<ul>\n<li>Ec</li>\n<li>Ep</li>\n<li>Es</li>\n<li>En</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>For <strong>anatomical</strong> classification:</p>\n<ul>\n<li>Superficial veins</li>\n<li>Perforator veins</li>\n<li>Deep veins</li>\n<li>No <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> location identified</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<ul>\n<li>As</li>\n<li>Ap</li>\n<li>Ad</li>\n<li>An</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>For <strong>pathophysiological </strong>classification:</p>\n<ul>\n<li>Reflux</li>\n<li>Obstruction</li>\n<li>Reflux and obstruction</li>\n<li>No <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> <span class=\"customMeta\" data-dictid=\"19bbbcd51e16927771947c31adcdd0\">pathophysiology</span> identified</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<ul>\n<li>Pr</li>\n<li>Po</li>\n<li>Pr,o</li>\n<li>Pn</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A baby playing unsupervised was brought with complaints of difficulty in swallowing for the last few hours. The x-ray image is given below. What is the diagnosis?", "options": [{"label": "A", "text": "Foreign body in the trachea", "correct": false}, {"label": "B", "text": "Foreign body in the esophagus", "correct": true}, {"label": "C", "text": "Artifact", "correct": false}, {"label": "D", "text": "Soft tissue calcification in the neck", "correct": false}], "correct_answer": "B. Foreign body in the esophagus", "question_images": ["https://image.prepladder.com/notes/VGUfYaAGU8TY4OpCDGBe1746450861.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Emergency</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Esophageal <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> (inability to handle oral secretions)</li>\n<li>Disk batteries</li>\n<li>Sharp-pointed objects</li>\n</ul>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Immediate <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">endoscopic</span> removal<strong> </strong></p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Urgent </strong></p>\n</td>\n<td rowspan=\"6\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Blunt objects</li>\n<li>Incomplete obstruction</li>\n<li>Multiple magnets (or single <span class=\"customMeta\" data-dictid=\"883e21a28016927771915738a46f85\">magnet</span> plus another ferromagnetic object within <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">endoscopic</span> reach)</li>\n<li>Coins</li>\n</ul>\n</td>\n<td rowspan=\"6\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Endoscopic removal within 12 to 24 hours<strong> </strong></p>\n<p> </p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Non Urgent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Objects in stomach &gt;2.5cm diameter</li>\n<li>Disc battery in the stomach for up to 48 <span class=\"customMeta\" data-dictid=\"136c4bdd441692777189c5b2e976a0\">hrs</span> if asymptomatic</li>\n<li>Blunt objects that fail to pass the stomach in 3-4 weeks</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Observation<strong> </strong></p>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What would be your immediate course of action in managing a patient who is experiencing bleeding from the surgical site following a tonsillectomy while in the recovery room?", "options": [{"label": "A", "text": "Shift to OT, remove the clots, and cauterize/ligate the vessel", "correct": true}, {"label": "B", "text": "Shift to OT, start IV antibiotics, and pack the tonsillar fossa", "correct": false}, {"label": "C", "text": "Give anticoagulants, repeated gargling, and wait for 24 hours", "correct": false}, {"label": "D", "text": "Do blood transfusion and wait and watch", "correct": false}], "correct_answer": "A. Shift to OT, remove the clots, and cauterize/ligate the vessel", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - Shift to OT, remove the clots, and cauterize/ligate the v\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is a drug called Mitomycin-C used for in medical treatment?", "options": [{"label": "A", "text": "Subglottic stenosis", "correct": true}, {"label": "B", "text": "Rhinocerebral mucormycosis", "correct": false}, {"label": "C", "text": "Adenoidectomy", "correct": false}, {"label": "D", "text": "Tympanoplasty", "correct": false}], "correct_answer": "A. Subglottic stenosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - &lt;span class=\"customMeta\" data-dictid=\"b83a5450d216927771990efacefc4c\"&gt;Subglottic&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most likely reason for a patient experiencing breathing difficulties and unsuccessful extubation after undergoing a total thyroidectomy?", "options": [{"label": "A", "text": "Superior laryngeal nerve injury", "correct": false}, {"label": "B", "text": "Unilateral recurrent laryngeal nerve injury", "correct": false}, {"label": "C", "text": "Bilateral recurrent laryngeal nerve injury", "correct": true}, {"label": "D", "text": "Hematoma", "correct": false}], "correct_answer": "C. Bilateral recurrent laryngeal nerve injury", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - &lt;span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\"&gt;Bilateral&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\"&gt;recurrent&lt;/span&gt; laryngeal nerve inju\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female patient came with complaints of nasal obstruction, loss of smell and foul smelling nasal discharge. On examination, presence of yellowish-green crusts in the nasal cavity along with merciful anosmia is observed. Which of the following additional findings may be observed in this patient?", "options": [{"label": "A", "text": "Roomy nasal cavity", "correct": true}, {"label": "B", "text": "Nasal polyps", "correct": false}, {"label": "C", "text": "Inferior turbinate hypertrophy", "correct": false}, {"label": "D", "text": "Foreign body", "correct": false}], "correct_answer": "A. Roomy nasal cavity", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - Roomy &lt;span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\"&gt;nasal&lt;/span&gt; cav\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient underwent surgery for breast carcinoma. She now presents with painless swelling involving the arm, as shown in the image below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Lymphedema", "correct": true}, {"label": "B", "text": "Lymphangiosarcoma", "correct": false}, {"label": "C", "text": "Venous thrombosis", "correct": false}, {"label": "D", "text": "Cellulitis", "correct": false}], "correct_answer": "A. Lymphedema", "question_images": ["https://image.prepladder.com/notes/YDn7eTTM1F3cVyiiXXVS1746451096.png"], "explanation_images": ["https://image.prepladder.com/content/Jr8p8iQDM1dvUBcOLRXJ1745475760.png", "https://image.prepladder.com/content/VWqaRyvHtlCQsaobeCBa1745475760.png", "https://image.prepladder.com/content/qG2R6gOneOrZFvVRDxGB1745475760.png", "https://image.prepladder.com/content/fgFCL6z8KA8o3QDXVawa1745475809.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An alcoholic patient presented with severe abdominal pain. Pancreatitis was suspected, and a CT scan revealed lesions with fluid collected near the body of the pancreas. Which of the following enzymes is most likely to be elevated?", "options": [{"label": "A", "text": "Serum GGT", "correct": false}, {"label": "B", "text": "CEA", "correct": false}, {"label": "C", "text": "Serum lipase", "correct": true}, {"label": "D", "text": "Serum bilirubin", "correct": false}], "correct_answer": "C. Serum lipase", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/J4BS6hZKh91lANvf7RLs1746451314.png", "https://image.prepladder.com/notes/KEMOv3frHXrq0JsobkOA1746451338.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:900px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<h4><strong>X-ray Features</strong></h4>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Sentinel loop sign</strong>:\n\t\t\t\t<ul>\n<li>Dilated loop of small <span class=\"customMeta\" data-dictid=\"7840cca3ed16927771901d2f6cb32b\">intestine</span> near the inflamed <span class=\"customMeta\" data-dictid=\"2e2fe8c6c116927771946fb9a8adb0\">pancreas</span> due to localised ileus.</li>\n<li><strong>Significance</strong>: Early indicator of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"98ea94d2c01692777194cc5ffee153\">pancreatitis</span> on X-ray.</li>\n</ul>\n</li>\n</ul>\n<p> </p>\n<p>Sentinel loop sign</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Sentinel loop sign\" data-author=\"Mohammad Niknejad\" data-hash=\"12074\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/sentinel-loop-acute-appendicitis-2#image-3004244\" data-tags=\"May2025\" height=\"226\" src=\"https://image.prepladder.com/notes/J4BS6hZKh91lANvf7RLs1746451314.png\" width=\"168\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Colon cut-off sign</strong>:\n\t\t\t\t<ul>\n<li>Abrupt <span class=\"customMeta\" data-dictid=\"a35c217ec416927772009a7f3b20f4\">termination</span> of gas in the <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> at the splenic flexure, with collapsed <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> loops.</li>\n<li><strong>Significance</strong>: Suggests localised pancreatic inflammation, causing <span class=\"customMeta\" data-dictid=\"566fcef0991692777184068f36db82\">colonic</span> <span class=\"customMeta\" data-dictid=\"0338b655da16927771984b872baabb\">spasm</span> as an <span class=\"customMeta\" data-dictid=\"2f73e160ba1692777190d65065c95b\">indirect</span> sign of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> pancreatitis</li>\n</ul>\n</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Colon cut-off sign\" data-author=\"Cerevisae\" data-hash=\"12077\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Colonic_cut_off_sign_on_chest_X-ray.jpg\" data-tags=\"May2025\" height=\"216\" src=\"https://image.prepladder.com/notes/KEMOv3frHXrq0JsobkOA1746451338.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 75-year-old man with prostate carcinoma presents to you with a PSA of 9 ng/mL with a small tumour focus. His Gleason score is 6. What will be your most likely management?", "options": [{"label": "A", "text": "Radical prostatectomy", "correct": false}, {"label": "B", "text": "External beam radiation", "correct": false}, {"label": "C", "text": "Brachytherapy", "correct": false}, {"label": "D", "text": "Active surveillance", "correct": true}], "correct_answer": "D. Active surveillance", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Gleason</strong></p>\n<p><strong>Score</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Grade</strong></p>\n<p><strong>Components</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Cancer</strong></p>\n<p><strong>Grade</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3 + 3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low-grade</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cells resemble healthy tissue; low likelihood of growth and spread.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>7</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3 + 4 or 4 + 3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intermediate-grade</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cells show more variation and moderate risk of growth and spread.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>8</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4 + 4, 3 + 5, or 5 + 3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High-grade</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cells look very different; higher likelihood of rapid growth and spread.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>9 or 10</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4 + 5, 5 + 4, or 5 + 5</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Very high-grade</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cells are highly aggressive and very likely to grow and spread quickly.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:606px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Management Strategy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Key Points</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Active Surveillance (Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>For low-risk cases, regular monitoring</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Radical <span class=\"customMeta\" data-dictid=\"4f419067a61692777196c1039e5eb3\">Prostatectomy</span> </strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Surgery for <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> cancer; potentially curative</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Radiation Therapy</strong></p>\n<p><strong>(Option B, C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High-energy rays; external or brachytherapy</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hormone Therapy </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reduces/block testosterone; for advanced/metastatic cases</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Chemotherapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Systemic drug treatment; for advanced/metastatic cases</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What should be the subsequent course of action in managing a patient who arrives at the emergency department with epistaxis, despite unsuccessful attempts to stop the bleeding by pinching the nostrils and nasal packing?", "options": [{"label": "A", "text": "Ligation of external carotid artery", "correct": false}, {"label": "B", "text": "Ligation of internal carotid artery", "correct": false}, {"label": "C", "text": "Ligation of sphenopalatine artery", "correct": true}, {"label": "D", "text": "Ligation of maxillary artery", "correct": false}], "correct_answer": "C. Ligation of sphenopalatine artery", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - &lt;span class=\"customMeta\" data-dictid=\"dcfb6667ee1692777191f00c3df2df\"&gt;Ligation&lt;/span&gt; of &lt;span class=\"customMeta\" data-dictid=\"cc57caf4a21692777199191e19c935\"&gt;sphenopalatine&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient was found to have a mass arising from the antrum of the stomach, which involves the head of the pancreas and metastasis to the right lobe of the liver. How will you manage this patient?", "options": [{"label": "A", "text": "Palliative gastrojejunostomy followed by chemotherapy", "correct": true}, {"label": "B", "text": "Radical gastrectomy", "correct": false}, {"label": "C", "text": "Whipple's procedure", "correct": false}, {"label": "D", "text": "Gastrectomy with right hepatectomy", "correct": false}], "correct_answer": "A. Palliative gastrojejunostomy followed by chemotherapy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with a history of chronic ear infection presents with fever, headache, vomiting, irritability, and confusion. His CT brain is shown in the image below. What is the possible diagnosis?", "options": [{"label": "A", "text": "Temporal lobe abscess", "correct": true}, {"label": "B", "text": "Cerebellar abscess", "correct": false}, {"label": "C", "text": "Subdural abscess", "correct": false}, {"label": "D", "text": "Meningitis", "correct": false}], "correct_answer": "A. Temporal lobe abscess", "question_images": ["https://image.prepladder.com/content/OTOIFD0uy5QIdthMUj0A1745476266.png"], "explanation_images": [], "explanation": "<p>Correct Answer A - &lt;span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\"&gt;Temporal&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\"&gt;lobe&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 54-year-old female patient presents with abdominal pain and bilious vomiting. She had a history of abdominal hysterectomy 2 years back. On examination, abdomen auscultation revealed high-pitched bowel sounds. Investigations showed air within the biliary tree. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Gallstone ileus", "correct": true}, {"label": "B", "text": "Adhesive intestinal obstruction", "correct": false}, {"label": "C", "text": "Ischemic enterocolitis", "correct": false}, {"label": "D", "text": "Diverticulitis", "correct": false}], "correct_answer": "A. Gallstone ileus", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/ibHave4RpDAsrsPtTuIj1746451658.png", "https://image.prepladder.com/notes/7rARuvcgVWB0GkLpuu0l1746451682.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient following a road traffic accident presented with subcutaneous emphysema. On auscultation, there was no air entry on the right side. Vitals were unstable. What will be your immediate management?", "options": [{"label": "A", "text": "Insertion of wide bore needle in the 2nd intercostal space", "correct": true}, {"label": "B", "text": "Wide bore needle decompression and IV fluids", "correct": false}, {"label": "C", "text": "Intubation and positive pressure ventilation", "correct": false}, {"label": "D", "text": "e-FAST", "correct": false}], "correct_answer": "A. Insertion of wide bore needle in the 2nd intercostal space", "question_images": ["https://image.prepladder.com/content/eEWziwvOucJMqFFRjwnJ1745476511.png"], "explanation_images": ["https://image.prepladder.com/content/um79fpU2bcRgJR0mq4pb1745476540.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with a hernia medial to the inferior epigastric artery. What is the most likely diagnosis and appropriate management for the same?", "options": [{"label": "A", "text": "Direct hernia and Bassini repair", "correct": false}, {"label": "B", "text": "Direct hernia and Lichtenstein mesh repair", "correct": true}, {"label": "C", "text": "Indirect hernia and Bassini repair", "correct": false}, {"label": "D", "text": "Indirect hernia and Lichtenstein mesh repair", "correct": false}], "correct_answer": "B. Direct hernia and Lichtenstein mesh repair", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/TGCeSJgMFrYGnGIS5Jru1745476695.png", "https://image.prepladder.com/content/WPQS38AEKyC5RRSTYuI41745476695.png", "https://image.prepladder.com/content/HfzCeD8Q4hueXSim6cGo1745476695.png", "https://image.prepladder.com/content/k2HjF9GXLAJkYYrsSbM71745476695.png", "https://image.prepladder.com/content/k1lm3DRog4dc9LIhhqi51745476695.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:900px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Bassini's Repair:</strong></p>\n<ul>\n<li>Involves suturing the internal oblique, <span class=\"customMeta\" data-dictid=\"b4b7ff709c1692777200a120b1b991\">transversus</span> abdominis, and <span class=\"customMeta\" data-dictid=\"65483c739e169277720294dce50377\">fascia</span> <span class=\"customMeta\" data-dictid=\"2c1c83a0da16927772000a37812afc\">transversalis</span> to the inguinal ligament. Known as a triple-layer repair.</li>\n<li>Higher <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> rates. <strong>(Option A ruled out)</strong></li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Anpol42\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Bassini_Operation._The_first_suture.jpg\" data-tags=\"\" height=\"298\" src=\"https://image.prepladder.com/content/TGCeSJgMFrYGnGIS5Jru1745476695.png\" width=\"200\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Shouldice Repair:</strong> involves a <strong>four-layer repair</strong> (double breasting of <span class=\"customMeta\" data-dictid=\"65483c739e169277720294dce50377\">fascia</span> transversalis), resulting in lower <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> rates compared to Bassini's.</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Kumar hari rajah M. Somanathan\" data-hash=\"\" data-license=\"CC BY 3.0\" data-source=\"https://www.researchgate.net/figure/The-shouldice-repair_fig2_376511441\" data-tags=\"\" height=\"142\" src=\"https://image.prepladder.com/content/WPQS38AEKyC5RRSTYuI41745476695.png\" width=\"200\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Modified Shouldice</strong>: A six-layer repair, including additional layers for reinforcement.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:656px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>TEP</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>TAPP</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Surgery done <strong>above the</strong> peritoneum</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Surgery done<strong> beneath the</strong> peritoneum</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Advantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Lower risk of <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> injury and peritoneal complications.</li>\n<li>Reduced risk of adhesions.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Larger working space</li>\n<li>Better visualisation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Disadvantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Smaller working spaces can make the procedure more technically challenging.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>A higher risk of <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> injury and <span class=\"customMeta\" data-dictid=\"2b1931a185169277718065e3fa42dd\">adhesion</span> formation due to entry into the peritoneal cavity.</li>\n<li>Potential for increased <span class=\"customMeta\" data-dictid=\"8f584900e71692777196a6e8943d4e\">postoperative</span> pain compared to TEP.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:664px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Indirect Inguinal Hernia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Direct Inguinal Hernia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common in</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Young adults</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elderly</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Course</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It enters through the deep inguinal ring, traverses the inguinal canal, and exits via the <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> inguinal ring.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Protrudes directly through <strong>Hesselbach's <span class=\"customMeta\" data-dictid=\"d398f22bb71692777201622867bda7\">triangle</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Relation to <span class=\"customMeta\" data-dictid=\"85e718f46f1692777198c656f33992\">Spermatic</span> Cord</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anterolateral to the <span class=\"customMeta\" data-dictid=\"85e718f46f1692777198c656f33992\">spermatic</span> cord</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Posterior to the <span class=\"customMeta\" data-dictid=\"85e718f46f1692777198c656f33992\">spermatic</span> cord</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Location of Neck of Sac</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Above and <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> to the <span class=\"customMeta\" data-dictid=\"fff48ca9da16927771966fd16bbacc\">pubic</span> tubercle.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lies within the Hesselbach's triangle.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Relation to <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">Inferior</span> Epigastric vessels</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lateral to the <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> epigastric vessels.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Medial to the <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> epigastric vessels.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Relation to Scrotum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Descends into the scrotum</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Does not Descend</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Bubonocele:</strong> Confined to inguinal canal</li>\n<li><strong>Funicular:</strong> Processus vaginalis closed above epididymis, <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> content distinct from testis</li>\n<li><strong>Complete/Scrotal:</strong> <span class=\"customMeta\" data-dictid=\"4269f77ac216927772001f9b8edeb9\">Testis</span> in the lower part of the hernia</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p> </p>\n<p style=\"text-align: center;\"><strong>—</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient arrives after being involved in a motorcycle road traffic accident. The patient does not report any pain or injury. Upon examination, there is evidence of blood at the urethral meatus. What would be your subsequent course of action in terms of managing this patient?", "options": [{"label": "A", "text": "Foley’s catheterization", "correct": false}, {"label": "B", "text": "Wait and watch", "correct": true}, {"label": "C", "text": "Nephrogram", "correct": false}, {"label": "D", "text": "Suprapubic cystostomy", "correct": false}], "correct_answer": "B. Wait and watch", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/4GIDQnvDJKGS8ie2bkPY1745476842.png", "https://image.prepladder.com/content/p8HSH1bSCM1v9DfNRWdz1745476842.png", "https://image.prepladder.com/content/UXArrtTgoohKqaPFYKi61745476842.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:900px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Anterior Urethral Injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Posterior Urethral Injury</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Bulbar <span class=\"customMeta\" data-dictid=\"a594ff734f16927772016f656d39eb\">urethra</span> (most common)</li>\n<li>Penile urethra</li>\n</ul>\n<p> </p>\n<p> </p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"200\" src=\"https://image.prepladder.com/content/p8HSH1bSCM1v9DfNRWdz1745476842.png\" width=\"200\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Membranous <span class=\"customMeta\" data-dictid=\"a594ff734f16927772016f656d39eb\">urethra</span> (bulbomembranous <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> most common)</li>\n<li>Prostatic urethra</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"200\" src=\"https://image.prepladder.com/content/UXArrtTgoohKqaPFYKi61745476842.png\" width=\"200\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Straddle injuries</li>\n<li>Direct trauma</li>\n<li>Iatrogenic injuries (catheterisation, cystoscopy)</li>\n<li>Penetrating trauma (stab/gunshot wounds)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Pelvic fractures (often due to motor vehicle accidents)</strong></li>\n<li>Blunt trauma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hematuria</li>\n<li>Penile/perineal bruising (butterfly-shaped hematoma)</li>\n<li>Perineal pain</li>\n<li>Urinary <span class=\"customMeta\" data-dictid=\"b668aed705169277719744b6db8f8e\">retention</span> or difficulty voiding</li>\n<li>Possible <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> of the <span class=\"customMeta\" data-dictid=\"028d70d3e11692777195f204ee2764\">penis</span> or <span class=\"customMeta\" data-dictid=\"cd68da1b781692777198beaa259249\">scrotum</span> due to hematoma</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Blood at the meatus</li>\n<li>Inability to void</li>\n<li>High-riding <span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\">prostate</span> on rectal exam</li>\n<li>Perineal or <span class=\"customMeta\" data-dictid=\"9011a765f816927771996863c4d12e\">suprapubic</span> pain</li>\n<li>Pelvic <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> associated with <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> fractures</li>\n<li>Possible <span class=\"customMeta\" data-dictid=\"ae1241d478169277718464d90eb75c\">concomitant</span> <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> injury</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Retrograde <span class=\"customMeta\" data-dictid=\"adb08c51431692777201ab86e23b39\">Urethrography</span> (RGU)</strong>: Gold standard, shows the extent and location of the injury</li>\n<li><strong>Voiding <span class=\"customMeta\" data-dictid=\"c65af338d916927771853b83a9c9c5\">Cystourethrography</span> (VCUG):</strong> Used to assess urethral <span class=\"customMeta\" data-dictid=\"8c660f0c321692777194046901e354\">patency</span> post-repair</li>\n<li><strong>Ultrasound:</strong> Can detect <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> or associated injuries</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Retrograde <span class=\"customMeta\" data-dictid=\"adb08c51431692777201ab86e23b39\">Urethrography</span> (RGU):</strong> Gold standard for initial assessment</li>\n<li><strong>CT Urethrography: </strong>Useful in evaluating complex injuries</li>\n<li><strong>Pelvic CT Scan: </strong>Important for associated <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> fractures</li>\n<li><strong>Cystoscopy: </strong>Sometimes performed for further evaluation</li>\n<li>If injury at Prostatomembranous <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> - High lying <span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\">prostate</span> → On IVP- Pie in-sky appearance.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Minor Injuries:</strong> Managed conservatively with catheterisation or <span class=\"customMeta\" data-dictid=\"9011a765f816927771996863c4d12e\">suprapubic</span> <span class=\"customMeta\" data-dictid=\"e5d34563e91692777183da2015189e\">catheter</span> if severe bruising</li>\n<li><strong>Severe Injuries:</strong> <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">Surgical</span> intervention like primary repair, urethroplasty, or end-to-end anastomosis</li>\n<li><strong>Antibiotics: </strong>To prevent infection</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Initial Management:</strong> <span class=\"customMeta\" data-dictid=\"9011a765f816927771996863c4d12e\">Suprapubic</span> <span class=\"customMeta\" data-dictid=\"9d9ad5903a1692777183f318310f4a\">catheterization</span> for <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> diversion</li>\n<li><strong>Delayed <span class=\"customMeta\" data-dictid=\"efb09641831692777201e1dcdc5f83\">Urethroplasty</span> (Definitive management):</strong> 3-6 months post-injury after <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> have subsided</li>\n<li><strong>Primary Realignment:</strong> Occasionally attempted if conditions permit</li>\n<li><strong>Endoscopic Realignment:</strong> For selected cases, though often reserved for <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> management</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Urethral <span class=\"customMeta\" data-dictid=\"329b77e4b11692777199930404f75c\">stricture</span> (risk of recurrence)</li>\n<li>Erectile <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> (especially if injury near the penile base)</li>\n<li>Urinary <span class=\"customMeta\" data-dictid=\"76979fe6ab16927771902f20401597\">incontinence</span> (less common)</li>\n<li>Infection (urethritis or <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> formation)</li>\n<li>Bladder neck contracture</li>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> syndrome</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with rectal prolapse underwent surgery. The postoperative image is given below. Identify the Procedure.", "options": [{"label": "A", "text": "Stapled hemorrhoidopexy", "correct": false}, {"label": "B", "text": "Well’s procedure", "correct": false}, {"label": "C", "text": "Thiersch wiring", "correct": true}, {"label": "D", "text": "Altemeier repair", "correct": false}], "correct_answer": "C. Thiersch wiring", "question_images": ["https://image.prepladder.com/notes/N1DKkVAJc2dLMJS97v1m1746452231.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:716px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<h5><strong>Aspect</strong></h5>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<h5><strong>Abdominal Rectopexy</strong></h5>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<h5><strong>Perineal Rectopexy</strong></h5>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Prosthetic or <span class=\"customMeta\" data-dictid=\"9e577f63b11692777192c8a84fbb61\">mesh</span> rectopexy-anterior/ posterior- <strong>Well's, Ripstein</strong></li>\n<li>Suture rectopexy- <strong>Lahaut</strong></li>\n<li>Anterior Resection</li>\n<li>Resection Rectopexy</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Mucosal sleeve <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> (<strong>Delrome's</strong>)</li>\n<li>Perineal recto <span class=\"customMeta\" data-dictid=\"c571bd042816927771984a81e88895\">sigmoidectomy</span> (<strong>Altemeier's</strong>)</li>\n<li>Posterior <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> of the <span class=\"customMeta\" data-dictid=\"9b9c4c412f1692777197ed217e7373\">rectum</span> of <strong>Lockhardt-Mummery </strong></li>\n<li><strong>Mickulicz Miles</strong> <span class=\"customMeta\" data-dictid=\"befda305051692777195a95ee0695a\">perineal</span> <span class=\"customMeta\" data-dictid=\"ebf9c40d2b16927772009a937efb25\">transanal</span> recto sigmoidectomy</li>\n<li>Anal encircling (<strong>Thiersch</strong>) <strong>(Option C)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Advantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Fixation of the <span class=\"customMeta\" data-dictid=\"9b9c4c412f1692777197ed217e7373\">rectum</span> provides adequate tension to prevent recurrence.</li>\n<li>Minimally <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> options (laparoscopic or robotic) offer benefits in pain control, hospital stay, and recovery time</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Lower <span class=\"customMeta\" data-dictid=\"f79470fd4a16927771940b525da4db\">operative</span> <span class=\"customMeta\" data-dictid=\"9b7604d5461692777192546af7cabd\">morbidity</span> and mortality, suitable for elderly or medically unfit patients.</li>\n</ul>\n<p> </p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Disadvantages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Requires extensive <span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\">dissection</span> and fixation, which may have higher <span class=\"customMeta\" data-dictid=\"9b7604d5461692777192546af7cabd\">morbidity</span> (10%-33%).</li>\n<li>Risk of mesh-related complications such as erosion, infection, <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> obstruction, and migration.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Higher <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> rates compared to <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> approaches</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Partial</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Complete</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Mucosal</li>\n<li>There is no <span class=\"customMeta\" data-dictid=\"e9449b4d7a16927771867eb16e2878\">descent</span> of the <span class=\"customMeta\" data-dictid=\"9e2d8a3f5a16927771932c2348ec52\">muscular</span> layer.</li>\n<li>It is the most common type of rectal prolapse.</li>\n<li>History of mass per anum, It is pink in colour and circumferential.</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Complete-full thickness.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"e9449b4d7a16927771867eb16e2878\">descent</span> contains all layers of the <span class=\"customMeta\" data-dictid=\"9b9c4c412f1692777197ed217e7373\">rectum</span> (i.e. including the <span class=\"customMeta\" data-dictid=\"9e2d8a3f5a16927771932c2348ec52\">muscular</span> layer).</li>\n<li>Complete <span class=\"customMeta\" data-dictid=\"e9449b4d7a16927771867eb16e2878\">descent</span> of <span class=\"customMeta\" data-dictid=\"9b9c4c412f1692777197ed217e7373\">rectum</span> as mass <span class=\"customMeta\" data-dictid=\"be836a0f5e169277719538e60bc715\">per anum</span> circumferentially, which is red in colour. Mass is usually <span class=\"customMeta\" data-dictid=\"7b497fabf51692777197384bc1248f\">reducible</span> and painless.</li>\n<li>It may be associated with <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> <span class=\"customMeta\" data-dictid=\"c49cc1bac4169277719692da7af2cc\">prolapse</span> (uterine procidentia) in females.</li>\n<li>Fecal <span class=\"customMeta\" data-dictid=\"76979fe6ab16927771902f20401597\">incontinence</span> (75%) is very common.</li>\n<li>Bleeding can occur because of the congestion.</li>\n<li>Sepsis, discharge, fever, and anaemia are other features.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient, after a road traffic accident, presented with pain in the abdomen. The resident examined the child and found that vitals were stable, and tenderness was present in the left lumbar region. Which is the best investigation of choice?", "options": [{"label": "A", "text": "Contrast-enhanced CT scan", "correct": true}, {"label": "B", "text": "Retrograde urethrogram", "correct": false}, {"label": "C", "text": "Wait and watch", "correct": false}, {"label": "D", "text": "Emergency laparotomy", "correct": false}], "correct_answer": "A. Contrast-enhanced CT scan", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A little boy was playing in a garden. Suddenly, he collapsed and was rushed to the hospital. His friend who played with him in the garden informed the doctors that he ate one of the fruits in the garden post which he seemed to have developed these symptoms. He also had irritability, restlessness, dry hot skin, and was unable to pass urine and stools. Identify the poison and its appropriate antidote.", "options": [{"label": "A", "text": "Datura, Pralidoxime", "correct": false}, {"label": "B", "text": "Datura, Physostigmine", "correct": true}, {"label": "C", "text": "Yellow oleander, Digoxin", "correct": false}, {"label": "D", "text": "Yellow oleander, Physostigmine", "correct": false}], "correct_answer": "B. Datura, Physostigmine", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Iq0FZpdZHQL0GszST2yv1745477985.png"], "explanation": "<p>Correct Option B - Datura, Physostigmine</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Toxicity </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Antidote </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Mechanism of action </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Datura/anticholinergics toxicity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Physostigmine</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inhibits <span class=\"customMeta\" data-dictid=\"63b92227451692777180db3901b72f\">acetylcholinesterase</span> enzyme</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Opium </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Naloxone</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Opioid <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antagonist</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Organophosphates </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Atropine</p>\n<p>Pralidoxime</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Muscarinic antagonist</p>\n<p>Cholinesterase reactivation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Acetaminophen </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>N-acetyl-cysteine</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Replenishes Glutathione</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Methanol </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fomepizole</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inhibitor of alcohol dehydrogenase</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Benzodiazepine </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Flumazenil</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inhibits GABA receptors</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cyanide </strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Eli Lilly <span class=\"customMeta\" data-dictid=\"5e612ce1381692777181adc76f11e6\">antidote</span> Kit (3-step approach)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ol>\n<li>Amyl nitrate: Oxidises haemoglobin to methemoglobin, which scavenges cyanide.</li>\n</ol>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ol>\n<li>Sodium nitrate: causes <span class=\"customMeta\" data-dictid=\"2cf30efe831692777185e200487656\">cyanide</span> to detach from the <span class=\"customMeta\" data-dictid=\"d4fff554a316927771885dc8700abe\">heme</span> group of <span class=\"customMeta\" data-dictid=\"29e8e2a5dd16927771855db589c581\">cytochrome</span> oxidase.</li>\n</ol>\n<ul>\n<li>Amyl <span class=\"customMeta\" data-dictid=\"ad09a76257169277719349e2735418\">nitrate</span> is used as a temporary measure until IV Sodium <span class=\"customMeta\" data-dictid=\"ad09a76257169277719349e2735418\">nitrate</span> can be given.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ol>\n<li>Sodium thiosulphate:It activates an <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> that converts <span class=\"customMeta\" data-dictid=\"2cf30efe831692777185e200487656\">cyanide</span> to a less toxic agent, thiocyanate.</li>\n</ol>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the lesion shown in the image below:", "options": [{"label": "A", "text": "Laceration", "correct": false}, {"label": "B", "text": "Incised wound", "correct": false}, {"label": "C", "text": "Laceration-looking incised wound", "correct": false}, {"label": "D", "text": "Incised looking laceration", "correct": true}], "correct_answer": "D. Incised looking laceration", "question_images": ["https://image.prepladder.com/notes/eot481DdxD8mmR2iotl91746452662.png"], "explanation_images": ["https://image.prepladder.com/content/6LdbFmSRnqD87s8zycgQ1745478547.png", "https://image.prepladder.com/content/nJ2LTOhHoG6b0JvSJTMl1745478561.png"], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"13e924e3cb169277719021021fc6d2\"&gt;Incised&lt;/span&gt; looking laceration</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Types of Laceration</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Mittal, Pawan &amp; Sharma, Balraj &amp; Mittal, Nancy.\" data-hash=\"\" data-license=\"CC BY-NC SA 4.0\" data-source=\"https://www.researchgate.net/figure/Split-laceration-triradiate-over-vertex-of-the-scalp-with-surrounding-cylindrical_fig14_369824161\" data-tags=\"\" height=\"254\" src=\"https://image.prepladder.com/content/6LdbFmSRnqD87s8zycgQ1745478547.png\" width=\"245\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Split <span class=\"customMeta\" data-dictid=\"ff7e91c542169277719182b4b8b68b\">Laceration</span> (Incised looking laceration)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>These occur when skin is crushed between two objects, such as the <span class=\"customMeta\" data-dictid=\"038a2a2fd4169277719894dc7db4bb\">scalp</span> being compressed between the skull and a hard surface like the ground or a <span class=\"customMeta\" data-dictid=\"324b1bfa7816927771834f9e3f6704\">blunt</span> object.</li>\n<li>Seen on areas where the skin is close to bone, with minimal underlying tissue</li>\n<li>E.g., scalp, eyebrows, cheekbones, jaw, <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> crest, perineum, shin.</li>\n<li>Lacerations without excessive skin crushing can have sharp edges, resembling <span class=\"customMeta\" data-dictid=\"13e924e3cb169277719021021fc6d2\">incised</span> wounds.</li>\n<li>Also known as <strong>incised looking laceration.</strong></li>\n<li>These are not undermined and show tissue bridges.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Avulsion (Shearing Laceration)</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Lim, Hyoseob &amp; Han, Dae &amp; Lee, Il &amp; Park, Myong.\" data-hash=\"\" data-license=\"CC BY-NC 4.0\" data-source=\"https://www.researchgate.net/figure/Case-2-preoperative-and-postoperative-photographs-A-An-avulsion-flap-injury-was-noted_fig3_261070181\" data-tags=\"\" height=\"233\" src=\"https://image.prepladder.com/content/nJ2LTOhHoG6b0JvSJTMl1745478561.png\" width=\"406\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Caused by a shearing force at an <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> angle, detaching skin or organs from their attachments.</li>\n<li>The shearing and <span class=\"customMeta\" data-dictid=\"c41ecd26ef1692777188314b57b1ff\">grinding</span> force from a heavy object, like a lorry wheel passing over a limb, can cause the skin to separate from the underlying tissues, a condition known as <span class=\"customMeta\" data-dictid=\"954dd74f031692777182664659765f\">avulsion</span> or \"flaying.\"</li>\n<li>This often results in crushed muscles and fractured bones. The detached skin may have extensive abrasions due to the tyre’s friction, but one portion is still in <span class=\"customMeta\" data-dictid=\"17e718612e1692777185f79acb759b\">continuity</span> with adjacent skin.</li>\n<li>Lacerations from shearing forces can leave the skin intact while separating the underlying soft tissue from the fascia, resulting in a blood-filled pocket. This type of injury is often observed on the back of the thighs in pedestrians hit by motor vehicles.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A man was working in a field and he suddenly collapsed on a hot summer afternoon. On examination, there were no physical signs of dehydration. His serum electrolyte level was normal. The doctor found that the body temperature was 106 degrees Fahrenheit. Which of the following symptoms is least likely to be seen in this patient?", "options": [{"label": "A", "text": "Hot skin", "correct": false}, {"label": "B", "text": "Hypotension", "correct": false}, {"label": "C", "text": "Sweating", "correct": true}, {"label": "D", "text": "Disorientation", "correct": false}], "correct_answer": "C. Sweating", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/kUhNKlkYQW5fMTGztv5M1745478907.png"], "explanation": "<p>Correct Option C - Sweating</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Postmortem Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Heat Stroke</p>\n<p> </p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Failure of <span class=\"customMeta\" data-dictid=\"f36a7c49d116927772002856c83dc1\">thermoregulation</span> in extreme heat exposure</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Sudden collapse-loss of consciousness, due to <span class=\"customMeta\" data-dictid=\"9402185d4b1692777189cb62891ff1\">hypotension</span> <strong>(Option B)</strong></li>\n<li>Skin hot, initially wet, then dry <strong>(Option A)</strong></li>\n<li>Hyperventilation- tachycardia</li>\n<li><strong>Core temp &gt; 40.5°C/104 F</strong></li>\n<li>Pupils contracted</li>\n<li>Convulsions</li>\n<li>Unconsciousness</li>\n<li>Cerebral <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> <strong>(Option D)</strong></li>\n<li>High fever</li>\n<li>Absence of <span class=\"customMeta\" data-dictid=\"8fab5233721692777199fc0bcd1210\">sweating</span> <strong>(Option C)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Congested lungs, <span class=\"customMeta\" data-dictid=\"09d1aa62351692777190c98d0dbb12\">intrathoracic</span> <span class=\"customMeta\" data-dictid=\"8fad605541169277719552afc9ebac\">petechiae</span> (children)</li>\n<li>Subendocardial hemorrhages</li>\n<li>Brain congestion, flattened convolutions, <span class=\"customMeta\" data-dictid=\"8fad605541169277719552afc9ebac\">petechiae</span> in the 3rd/4th <span class=\"customMeta\" data-dictid=\"707de303e516927772011cb80f4028\">ventricle</span> walls</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young teenage boy with a history of drug abuse had been instilled with a shot of intravenous cocaine at a party. He is rushed to the emergency room by his friends. Some of the symptoms were diaphoresis, headache, and acute coronary spasm. Which of the following symptoms noted would go against the likely diagnosis of cocaine poisoning?", "options": [{"label": "A", "text": "Myocardial ischemia", "correct": false}, {"label": "B", "text": "Bradycardia", "correct": true}, {"label": "C", "text": "Hyperthermia", "correct": false}, {"label": "D", "text": "Agitation", "correct": false}], "correct_answer": "B. Bradycardia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/HPHMN0KyS4o7VfA2NYvT1745479094.png"], "explanation": "<p>Correct Option B - Bradycardia</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Cocaine </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Origin </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Leaves of Erythroxylum coca</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\" Enn1.jpg: Dbotany derivative work: Ilmari Karonen\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Coca#/media/File:Erythroxylum_novogranatense_var._Novogranatense_(retouched).jpg\" data-tags=\"\" height=\"220\" src=\"https://image.prepladder.com/content/HPHMN0KyS4o7VfA2NYvT1745479094.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Local names </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Coke, snow, Cadillac, White lady</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Physical properties</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Colourless, odourless, crystalline, bitter taste</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism of action</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>It is a potent central nervous system (CNS) <span class=\"customMeta\" data-dictid=\"bec9bb02501692777199b0f75e340e\">stimulant</span> that produces initial <span class=\"customMeta\" data-dictid=\"41b8036e5416927771870abd5bdbc2\">euphoria</span> and increased energy, followed by depression as its effects wear off.</li>\n<li>It enhances alertness and activity while stimulating the <span class=\"customMeta\" data-dictid=\"bd1c98736616927771820954b0a744\">autonomic</span> nervous system, leading to increased heart rate and elevated blood pressure.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Route of administration </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Snorting, Smoking, IV injection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Signs of abuse</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Septal perforation</li>\n<li>Crack hands (multiple blackened, hyperkeratotic lesions on the fingers and palms).</li>\n<li>Black <span class=\"customMeta\" data-dictid=\"3b007026bd16927771997ae809b603\">staining</span> of tongue and teeth</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Effects </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Stages </strong></p>\n<p><strong>1. Stage of excitement </strong></p>\n<ul>\n<li>Feeling of well-being</li>\n<li>Loss of depression and fatigue</li>\n<li>Excited and restless <strong>(Option D)</strong></li>\n<li>Tingling sensation in hands and feet</li>\n<li><strong>Increased heart rate (Option B)</strong></li>\n<li>Increase in temperature <strong>(Option C)</strong></li>\n<li>Rapid and deep respiration</li>\n</ul>\n<p> </p>\n<p><strong>2. Stage of depression</strong></p>\n<ul>\n<li>Profuse perspiration</li>\n<li>Convulsion</li>\n<li>Reduced <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> rate</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Cardiac arrhythmia<strong> </strong></li>\n<li>Cardiac failure</li>\n<li>Cardiovascular collapse</li>\n<li>Cerebrovascular accident</li>\n<li>Aortic dissection</li>\n<li>Myocardial <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">infarction</span> <strong>(Option A)</strong></li>\n<li>Skin necrosis</li>\n<li>Intracerebral hemorrhage</li>\n<li>Formication (Cocaine Bugs)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management of fatal dose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Maintain airway, breathing and circulation</li>\n<li>If ingested: Gastric <span class=\"customMeta\" data-dictid=\"b625b3e881169277719169ef4e1af3\">lavage</span> with <strong>potassium permanganate</strong></li>\n<li>If snorted: <strong>Wash the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> <span class=\"customMeta\" data-dictid=\"26080f047a169277719334625cadef\">mucous</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> with water</strong></li>\n<li>If injected: <strong>Ligature</strong> over the <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">injection</span> site</li>\n<li><strong>Amyl <span class=\"customMeta\" data-dictid=\"8866b36aa016927771938ffb10b429\">nitrite</span> </strong>via <span class=\"customMeta\" data-dictid=\"0b1500fcd816927771900b59d16bde\">inhalation</span> route</li>\n<li><strong>Thiamine 100 mg IV injection</strong></li>\n<li><strong>Naloxone <span class=\"customMeta\" data-dictid=\"eef118d8f31692777189e54df45163\">hydrochloride</span> 2mg IV <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">injection</span> </strong></li>\n<li>Symptomatic management for convulsions using <strong>barbiturates</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The phenomenon shown below is typically seen in the case of ?", "options": [{"label": "A", "text": "Case of torture phalanges", "correct": false}, {"label": "B", "text": "Case of suspension or hanging more than 72 hours", "correct": false}, {"label": "C", "text": "Case of immersion in water for 36 hours", "correct": true}, {"label": "D", "text": "Case of colliquative liquefaction due to immersion in hot water", "correct": false}], "correct_answer": "C. Case of immersion in water for 36 hours", "question_images": ["https://image.prepladder.com/notes/W2kSVC1SXVJYRsfjUTaD1746452898.png"], "explanation_images": ["https://image.prepladder.com/notes/W2kSVC1SXVJYRsfjUTaD1746452898.png"], "explanation": "<p>Correct Option C - Case of &lt;span class=\"customMeta\" data-dictid=\"a41dc7c0d41692777189383fa9a445\"&gt;immersion&lt;/span&gt; in water for 36 hours</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Immersion Syndrome (Trench/Immersion Foot/Hand)</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"Immersion Syndrome\" data-author=\"Mehmet Karatay\" data-hash=\"12100\" data-license=\"CC BY SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Trench_foot\" data-tags=\"May2025\" height=\"231\" src=\"https://image.prepladder.com/notes/W2kSVC1SXVJYRsfjUTaD1746452898.png\" width=\"200\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Prolonged exposure to severe cold (&lt;10ºC) and dampness (common in warfare, trenches, or sea immersion)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Affects extremities (feet, hands)</li>\n<li>Cold, numbness, burning, cyanosis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Air drying, protecting extremities from trauma and infection, gradual rewarming by <span class=\"customMeta\" data-dictid=\"46860a8053169277718175e8e491fa\">air exposure</span> at <span class=\"customMeta\" data-dictid=\"82897eb3821692777197ca2f192349\">room temperature</span> (avoid heat, massaging, or moistening the skin)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the active principle of the poison shown in the image?", "options": [{"label": "A", "text": "Ricin", "correct": false}, {"label": "B", "text": "Bhilawanol", "correct": true}, {"label": "C", "text": "Abrin", "correct": false}, {"label": "D", "text": "Calotropin", "correct": false}], "correct_answer": "B. Bhilawanol", "question_images": ["https://image.prepladder.com/notes/cvPtPlJc7e5NHFb9Dyid1746453061.png"], "explanation_images": ["https://image.prepladder.com/notes/XVx9PUh4VrlRXjtT9SAP1746453076.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is true regarding the post-mortem change shown in the image given below?", "options": [{"label": "A", "text": "Seen within first 12 hours of death", "correct": false}, {"label": "B", "text": "It occurs due to the accumulation of deoxygenated blood", "correct": false}, {"label": "C", "text": "It results due to bacterial activity", "correct": true}, {"label": "D", "text": "It is seen in case of lightning", "correct": false}], "correct_answer": "C. It results due to bacterial activity", "question_images": ["https://image.prepladder.com/content/heikDW0MfQqA6tkksXSP1745480194.png"], "explanation_images": ["https://image.prepladder.com/content/W0yAsP59tvJBH7m81rdU1745480243.png", "https://image.prepladder.com/notes/LUm7NHGyWsDPCHUu2ZJF1746453290.png", "https://image.prepladder.com/content/LwSI5Iq0AEzhIjJE7hSe1745480304.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Marbling</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Refers to a characteristic pattern in the skin caused by decomposition.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>After death, bacteria <strong>(Option C) </strong>spread through blood vessels, decomposing <span class=\"customMeta\" data-dictid=\"ad2073fe6716927771885f3c1ec652\">hemoglobin</span> into <span class=\"customMeta\" data-dictid=\"acf909f93d1692777199d72e77fe24\">sulfmethemoglobin</span> <strong>(Option B)</strong>, which causes greenish or reddish-brown <span class=\"customMeta\" data-dictid=\"3b007026bd16927771997ae809b603\">staining</span> of the vessel walls.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pattern </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Marbled pattern follows a <span class=\"customMeta\" data-dictid=\"d02067c4b51692777191b8eec8b062\">linear</span> branching pattern, resembling tree branches, which initially appears red and later transitions to a greenish hue.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Onset and Timing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Begins to develop 24 hours after death.</li>\n<li>Becomes prominent by 36-48 hours.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Color Changes Over Time</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Skin’s reddish-green marbling may turn dark green or nearly black within 3 to 4 days.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Areas of Marbling</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Shoulders, roots of the limbs, thighs, sides of the abdomen, chest, and neck.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Medicolegal Importance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Helps in determining the time since death</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Image </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"M. Lee Goff\" data-hash=\"\" data-license=\"NA\" data-source=\"https://emedicine.medscape.com/article/1680032-overview?form=fpf\" data-tags=\"\" height=\"218\" src=\"https://image.prepladder.com/content/W0yAsP59tvJBH7m81rdU1745480243.png\" width=\"370\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Feature </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Marbling </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Filigree Burns (Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Nature </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Postmortem pattern in the skin caused by bacterial decomposition.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Superficial thin, <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> and <span class=\"customMeta\" data-dictid=\"4632fe89141692777200f671693e55\">tortuous</span> skin markings caused by lightning or electrical discharge.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Onset </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Starts within 24 hours after death <strong>(Option A).</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Appears within minutes to an hour of the electrical accident.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Colour</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Starts reddish-green and eventually dark green or black.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Red</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Site of Occurrence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Blood vessels</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Skin surface</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Image </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; text-align:center; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Marbling\" data-author=\"M. Lee Goff\" data-hash=\"12106\" data-license=\"NA\" data-source=\"https://emedicine.medscape.com/article/1680032-overview?form=fpf\" data-tags=\"May2025\" height=\"204\" src=\"https://image.prepladder.com/notes/LUm7NHGyWsDPCHUu2ZJF1746453290.png\" width=\"346\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Mahajan, Prof Ajay &amp; Rajan, Ruchika &amp; Regan, Padraic. \" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/Characteristic-Lichtenberg-figures-seen-on-the-right-side-of-the-neck-chest-abdomen-and_fig1_6175256\" data-tags=\"\" height=\"276\" src=\"https://image.prepladder.com/content/LwSI5Iq0AEzhIjJE7hSe1745480304.png\" width=\"200\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the appropriate term to describe a person who sits naked on their balcony, deriving sexual pleasure from observing others looking at them, while overlooking a park?", "options": [{"label": "A", "text": "Voyeurism", "correct": false}, {"label": "B", "text": "Fetishism", "correct": false}, {"label": "C", "text": "Exhibitionism", "correct": true}, {"label": "D", "text": "Masochism", "correct": false}], "correct_answer": "C. Exhibitionism", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Sadism/Algolagnia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Getting satisfaction by giving pain to a partner.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Masochism/</strong></p>\n<p><strong>Passive <span class=\"customMeta\" data-dictid=\"4a300ea1811692777181d1033c8c53\">Algolagnia</span> (Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Getting satisfaction by receiving pain from a partner.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Bondage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Combination of <span class=\"customMeta\" data-dictid=\"d4db6ca817169277719840d027ecb1\">Sadism</span> and Masochism.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Lust Murder</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Murder acts as a stimulus for sexual arousal.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Urolagnia/Undinism/</strong></p>\n<p><strong>Urophilia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Sexual <span class=\"customMeta\" data-dictid=\"bf639c9a2316927771825e1632d9fb\">arousal</span> from <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> smell, touch, or sight.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Uranism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Sexual gratification by fingering, fondling, licking, or sucking the <span class=\"customMeta\" data-dictid=\"a6a00bd30e169277718892b3a6076c\">genitalia</span> of the opposite sex</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Coprophilia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Sexual <span class=\"customMeta\" data-dictid=\"bf639c9a2316927771825e1632d9fb\">arousal</span> from fecal smell and touch.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Sexual Oralism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Fellatio: Oral <span class=\"customMeta\" data-dictid=\"7f3792072b1692777199fd8e2c4f59\">stimulation</span> of male genitalia.</li>\n<li>Cunnilingus: Oral <span class=\"customMeta\" data-dictid=\"7f3792072b1692777199fd8e2c4f59\">stimulation</span> of female genitalia<strong> </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Exhibitionism (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Showing private parts.</p>\n<ul>\n<li>Streaking: Running naked in public.</li>\n<li>Mooning: Showing bare <span class=\"customMeta\" data-dictid=\"a0af4564cf1692777183e503d226f6\">buttocks</span> (Mnemonic: Moon resembles buttocks)</li>\n<li>Flashing: Momentarily exposing body parts by quickly moving clothing (Mnemonic: like a flashlight)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Necrophilia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Sexual activity with a dead body.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Necrophagia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Eating parts of a dead body.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Fetishism(Option B</strong>)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Sexual satisfaction from <span class=\"customMeta\" data-dictid=\"47755ae5261692777190f28393bfca\">inanimate</span> objects like bras or underpants (Common in males)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Voyeurism/Scoptophilia/</strong></p>\n<p><strong>Peeping Tom (Option A</strong>)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Watching someone undress or bathe (Specifically females)</p>\n<p>Mixoscopia: Sexual gratification from watching others engage in sex.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A woman gave birth to twins. The father who believed that they did not belong to him requested DNA testing. After testing, it was found that one child did not belong to him. This case would be best described as?", "options": [{"label": "A", "text": "Superfetation", "correct": false}, {"label": "B", "text": "Superfecundation", "correct": true}, {"label": "C", "text": "Suppositious child", "correct": false}, {"label": "D", "text": "Atavism", "correct": false}], "correct_answer": "B. Superfecundation", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/4lAlShUr8YagcbPjDjRH1745480785.png"], "explanation": "<p>Correct Option B - Superfecu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "While recording evidence in the court of law, the opposing lawyer asked the witness, “Did A kill B in your presence?” The witness said, “Yes”. Which procedural route would this type of question be permitted in the court of law?", "options": [{"label": "A", "text": "Examination-in-chief", "correct": false}, {"label": "B", "text": "Direct examination", "correct": false}, {"label": "C", "text": "Cross-examination", "correct": true}, {"label": "D", "text": "Re-direct examination", "correct": false}], "correct_answer": "C. Cross-examination", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Cross-examination</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Examination-in-Chief (Direct Examination) (Option A and B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Cross-Examination (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Re-Examination (Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\"><strong>Conducted By</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Party who calls the witness (e.g., public prosecutor)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Opposing party (typically defense)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Party who called the witness</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\"><strong>Purpose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Present all relevant facts</li>\n<li>Provide expert interpretation if applicable</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>Challenge witness's credibility</strong></li>\n<li><strong>Elicit favorable facts</strong></li>\n<li><strong>Test accuracy</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Clarify issues raised during cross-examination</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\"><strong>Leading Questions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Not allowed unless the witness is declared hostile</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Allowed (<strong>Sec. 146 BSA</strong>)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Not allowed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\"><strong>Nature of Questions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Open-ended questions to elicit narrative</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Can include leading questions to control the narrative</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Generally clarifying questions</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\"><strong>Time Limit</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Typically structured and may have time constraints</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>No set time limit; may last for hours or even days</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Generally limited to <span class=\"customMeta\" data-dictid=\"68c95b7b5a169277718451643a0b35\">clarification</span> purposes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align: center;\"><strong>Judicial Oversight</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Judge may intervene to ensure questions are relevant and not leading</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Court can disallow indecent or scandalous questions (Sec. 154, BSA)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Judge monitors to ensure focus remains on clarification</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The most common heart defect in congenital rubella syndrome is:", "options": [{"label": "A", "text": "ASD", "correct": false}, {"label": "B", "text": "VSD", "correct": false}, {"label": "C", "text": "PDA", "correct": true}, {"label": "D", "text": "Pulmonary stenosis", "correct": false}], "correct_answer": "C. PDA", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Associated Heart Defects (Order)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Infections</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Rubella Virus (German Measles)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Patent <span class=\"customMeta\" data-dictid=\"7a6864e97b169277718602072817ee\">Ductus</span> Arteriosus (PDA) &gt; <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">Stenosis</span> &gt; <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">Ventricular</span> Septal <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">Defect</span> (VSD) / Atrial Septal <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">Defect</span> (ASD)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cytomegalovirus (CMV) Infection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ventricular Septal <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">Defect</span> (VSD) &gt; Atrial Septal <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">Defect</span> (ASD) &gt; Patent <span class=\"customMeta\" data-dictid=\"7a6864e97b169277718602072817ee\">Ductus</span> Arteriosus (PDA)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Toxoplasmosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ventricular Septal <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">Defect</span> (VSD) &gt; Patent <span class=\"customMeta\" data-dictid=\"7a6864e97b169277718602072817ee\">Ductus</span> Arteriosus (PDA)</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Metabolic Defects</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Maternal Diabetes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Transposition of the <span class=\"customMeta\" data-dictid=\"fa1831d5c016927771886f0447bc65\">Great Vessels</span> (TGV) &gt; <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">Ventricular</span> Septal <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">Defect</span> (VSD) / Atrial Septal <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">Defect</span> (ASD)</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Genetic Disorders</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Down Syndrome (Trisomy 21)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Atrioventricular Septal <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">Defect</span> (AVSD) &gt; <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">Ventricular</span> Septal <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">Defect</span> (VSD) &gt; Patent <span class=\"customMeta\" data-dictid=\"7a6864e97b169277718602072817ee\">Ductus</span> Arteriosus (PDA)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Turner Syndrome (45,X)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Coarctation of the <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">Aorta</span> &gt; <span class=\"customMeta\" data-dictid=\"9461b5b89b16927771839fb979168f\">Bicuspid</span> <span class=\"customMeta\" data-dictid=\"59a120854e16927771820318aebd4a\">Aortic Valve</span> &gt; Aortic Stenosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Noonan Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pulmonary <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">Stenosis</span> &gt; Atrial Septal <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">Defect</span> (ASD) &gt; Hypertrophic <span class=\"customMeta\" data-dictid=\"6e6dd7aed216927771831ebdf9703c\">Cardiomyopathy</span> (HCM)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Williams Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Supravalvular <span class=\"customMeta\" data-dictid=\"b0c55e5f1916927771820b0864074e\">Aortic Stenosis</span> (SVAS) &gt; <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">Stenosis</span> &gt; Aortic Stenosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>DiGeorge Syndrome (22q11.2 Deletion)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tetralogy of Fallot (TOF) &gt; <span class=\"customMeta\" data-dictid=\"fb9eb5785916927771900fcb6718d4\">Interrupted</span> Aortic <span class=\"customMeta\" data-dictid=\"9a89dd67841692777182ee412af263\">Arch</span> &gt; <span class=\"customMeta\" data-dictid=\"1b87e4855b16927772008ed8e29e8c\">Truncus</span> Arteriosus</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Drugs</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Thalidomide</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tetralogy of Fallot (TOF) &gt; <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">Ventricular</span> Septal <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">Defect</span> (VSD) &gt; <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">Artery</span> Stenosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lithium</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ebstein <span class=\"customMeta\" data-dictid=\"50a440f85816927771817d2fe50984\">Anomaly</span> &gt; Atrial Septal <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">Defect</span> (ASD)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 210 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 200 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A woman during her routine examination presents with the following X-ray finding. What is her most likely diagnosis?", "options": [{"label": "A", "text": "A multiple brown tumour", "correct": false}, {"label": "B", "text": "Fibrous dysplasia", "correct": false}, {"label": "C", "text": "Multiple Enchondromas", "correct": true}, {"label": "D", "text": "Multiple exostoses", "correct": false}], "correct_answer": "C. Multiple Enchondromas", "question_images": ["https://image.prepladder.com/notes/mnRPewBpKYvvfbY1u0221746272959.png"], "explanation_images": ["https://image.prepladder.com/content/W0GKhhoNsToGhU7dHwJF1745317458.png", "https://image.prepladder.com/notes/vtioSH6wx3mOhj9KrPrD1746273027.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:607px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Usually diagnosed in childhood</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Most chondromas found in <span class=\"customMeta\" data-dictid=\"b9f9358d0d1692777195323daee87f\">phalangeal</span> bones</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Ollier disease\" data-author=\"Atalay, İsmail Burak &amp; Yilmaz, Selcuk &amp; Şimşek, Mehmet &amp; Ekşioğlu, Mehmet &amp; Güngör, Bedii\" data-hash=\"11630\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/Ollier-disease-bilateral-and-multiple-involvement_fig1_324138529\" data-tags=\"May2025\" height=\"528\" src=\"https://image.prepladder.com/notes/vtioSH6wx3mOhj9KrPrD1746273027.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common findings:</strong></p>\n<ul>\n<li>Asymmetric limb shortening</li>\n<li>Swelling of fingers/toes</li>\n<li>Impaired movement of <span class=\"customMeta\" data-dictid=\"65604d11831692777190c5ea442405\">interphalangeal</span> joints</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Distribution</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Can be <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> or bilateral</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Progression</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>New chondromas typically stop after puberty</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tumor growth in adulthood may indicate malignancy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Risk of <span class=\"customMeta\" data-dictid=\"c0c247b89916927771948bc5e6d39c\">pathological</span> fractures</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Malignant Transformation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>20-30% risk of secondary chondrosarcoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Transformation usually occurs in the 30s or 40s</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Warning signs:</strong></p>\n<ul>\n<li>Increase in size of existing chondroma</li>\n<li>New symptoms</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is true about the type of fixation shown in the image?", "options": [{"label": "A", "text": "Fracture tibia, ilizarov fixator", "correct": false}, {"label": "B", "text": "Fracture tibia, spanning fixator", "correct": false}, {"label": "C", "text": "Fracture femur, spanning fixator", "correct": false}, {"label": "D", "text": "Periarticular fracture of knee, spanning fixator", "correct": true}], "correct_answer": "D. Periarticular fracture of knee, spanning fixator", "question_images": ["https://image.prepladder.com/notes/pH15rkl8FoyZcLtPiGyy1746273192.png"], "explanation_images": ["https://image.prepladder.com/notes/pH15rkl8FoyZcLtPiGyy1746273192.png", "https://image.prepladder.com/notes/40YPsDBH3WuaudY27Kkd1746273322.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Definition</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>A type of external <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> device used to stabilize fractures or deformities, spanning over a joint.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Indications</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Complex fractures</li>\n<li>Joint instability</li>\n<li>Bone deformities</li>\n<li>Temporary <span class=\"customMeta\" data-dictid=\"6694ddb1db1692777199c9a1e38bf0\">stabilization</span> during healing</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Types</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Unilateral fixator</li>\n<li>Bilateral fixator</li>\n<li>Circular fixator</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mechanism of Action</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"92985ebc231692777202e3345af0aa\">fixator</span> applies external support to <span class=\"customMeta\" data-dictid=\"87bf05a56616927771893b9550e8ad\">immobilize</span> the fractured area and maintain proper <span class=\"customMeta\" data-dictid=\"3c0c325f4216927771819e5d0eb581\">alignment</span> while healing.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Advantages</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Minimizes <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> exposure</li>\n<li>Adjustable design</li>\n<li>Can be used in complex fractures</li>\n<li>Can be applied to both long bones and joints</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Disadvantages</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pin-site infections</li>\n<li>Risk of soft tissue damage</li>\n<li>Aesthetic concerns due to external frame</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Duration of Use</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Typically used temporarily, but can be extended depending on the severity of the <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> or injury.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A male patient presented with the fracture of Tibia following a road traffic accident. He was managed appropriately, but after 2 days he developed dyspnea, petechiae involving the whole body, and a fall in oxygen saturation. What is the likely diagnosis?", "options": [{"label": "A", "text": "Fat embolism", "correct": true}, {"label": "B", "text": "Air embolism", "correct": false}, {"label": "C", "text": "Venous thromboembolism", "correct": false}, {"label": "D", "text": "Pulmonary hypertension", "correct": false}], "correct_answer": "A. Fat embolism", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A) Fat Embolism</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Major criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Minor criteria</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Respiratory <span class=\"customMeta\" data-dictid=\"80feaae4b31692777190ea1ba3fc25\">insufficiency</span> (symptoms and radiologic evidence)</strong></li>\n<li><strong>Cerebral <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> not caused by head injury or other conditions</strong></li>\n<li><strong>Petechial rash</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Tachycardia (&gt;110 beats/min)</li>\n<li>Pyrexia (temperature &gt;38.5°C)</li>\n<li>Retinal changes (fat or petechiae)</li>\n<li>Renal dysfunction</li>\n<li>Jaundice</li>\n<li>Acute drop in haemoglobin</li>\n<li>Sudden thrombocytopenia</li>\n<li>Elevated ESR</li>\n<li>Fat macroglobulinemia.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An intrauterine scan at the 13th week of pregnancy showed a fetus with multiple long bone fractures. What is commonly associated with this finding?", "options": [{"label": "A", "text": "Achondroplasia", "correct": false}, {"label": "B", "text": "Osteogenesis imperfecta", "correct": true}, {"label": "C", "text": "Cretinism", "correct": false}, {"label": "D", "text": "Marfan syndrome", "correct": false}], "correct_answer": "B. Osteogenesis imperfecta", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/fUgMZVLOwZCxnRuZb07M1746273437.png", "https://image.prepladder.com/notes/udwgPOLo0Uj4xA1INihk1746273501.png", "https://image.prepladder.com/notes/P7PvR2y5DFLiRcYRLsag1746273549.png", "https://image.prepladder.com/notes/s6sXKQQ4KXk25XVUejfT1746273603.png", "https://image.prepladder.com/notes/A26aMcZEQD6ce8ZLyO3N1746273684.png", "https://image.prepladder.com/notes/NDbVRiWY0yjJZXKjUCaf1746273866.png", "https://image.prepladder.com/notes/8GeGV6HkgDt5q8egGdqC1746273910.png", "https://image.prepladder.com/notes/vQ1m6AoqIOaT7OGwwU6O1746273958.png", "https://image.prepladder.com/content/6r1M36tfiMupyCcvZ9gr1745318145.png", "https://image.prepladder.com/content/cc39toxaPtT6iSk0Emja1745318145.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most common Late complication of this condition, if left untreated ?", "options": [{"label": "A", "text": "Pulled elbow", "correct": false}, {"label": "B", "text": "Dinner fork deformity", "correct": false}, {"label": "C", "text": "Cubitus varus", "correct": true}, {"label": "D", "text": "Osteoarthritis", "correct": false}], "correct_answer": "C. Cubitus varus", "question_images": ["https://image.prepladder.com/notes/g3VWZCnUPPuUEkbKSP6x1746274099.png"], "explanation_images": ["https://image.prepladder.com/notes/aKLk0RcsA5Vp0BDvq6eQ1746274159.png", "https://image.prepladder.com/content/b7FDzFHCrTmkduo4KEKV1745319048.png", "https://image.prepladder.com/content/SecmgudfRgwYplMFNJmJ1745319033.png", "https://image.prepladder.com/content/vkIcI8oExlfM5qE4eqTX1745319028.png", "https://image.prepladder.com/content/eYT9HKESqBIVJb7BcQML1745319021.png", "https://image.prepladder.com/content/S0UoKChAXAi5TSyyJqR11745318996.png", "https://image.prepladder.com/content/I8BEpoRtYEeEsNnFsRiY1745318987.png", "https://image.prepladder.com/content/EERfIMY2ZsJWTRPXNRS31745318959.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:638px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Supracondylar Fractures </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism of injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fall on outstretched hand (FOOSH)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Humerus fractures just above the condyles.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Displacements</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> fragment of the <span class=\"customMeta\" data-dictid=\"a547f4a22716927771897daf6b50e7\">humerus</span> is usually displaced by</p>\n<ul>\n<li>Posterior shift (Due to Impaction)</li>\n<li>Posterior Tilt</li>\n<li>Proximal shift</li>\n<li>Medial shift/ Tilt</li>\n<li>Internal rotation</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"Displacements of Supracondylar Fractures\" data-author=\"\" data-hash=\"11643\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" height=\"350\" src=\"https://image.prepladder.com/notes/aKLk0RcsA5Vp0BDvq6eQ1746274159.png\" width=\"350\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Type 1:</strong> Undisplaced fracture</li>\n<li><strong>Type 2:</strong> Partially displaced <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> with <span class=\"customMeta\" data-dictid=\"5a50cd774d1692777186c56ec68eac\">displacement</span> of only <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> cortex</li>\n<li><strong>Type 3:</strong> Completely displaced <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> cortex.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Severe elbow pain, swelling, deformity, and loss of function may occur, and neurological symptoms like weakness in wrist <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> or the <strong>\"hand of benediction\"</strong> sign may also occur if the<strong> <span class=\"customMeta\" data-dictid=\"979385c98a1692777192fb1721a16e\">median</span> nerve</strong> is affected.</li>\n<li>Unusual <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"ebc4d593fd1692777196b50a4faad4\">prominence</span> of the <span class=\"customMeta\" data-dictid=\"42c351f10a1692777194fbc64fc061\">olecranon</span> in the backward tilt <strong>(S-shaped deformity)</strong></li>\n<li>The skin around the <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> has a dimpled appearance <strong>(Dimple sign)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>X-ray Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Three bony parts relationship is maintained.</li>\n<li><strong>Fat Pad or Sail sign: </strong>A <span class=\"customMeta\" data-dictid=\"4537d6e7e216927772007d067522aa\">translucent</span> shadow-like appearance representing <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> fat pads.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Hellerhoff \" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Fat_pad_sign#/media/File:Fettpolsterzeichen_pathologisch_Ellenbogen.png\" data-tags=\"\" height=\"362\" src=\"https://image.prepladder.com/content/b7FDzFHCrTmkduo4KEKV1745319048.png\" width=\"350\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Disturbed tear drop sign:</strong> An <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> appearance of the fat pad, suggesting the presence of an injury, such as a <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> or joint effusion.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Hellerhoff \" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Supracondylar_process_of_the_humerus#/media/File:Processus_supracondylaris.jpg\" data-tags=\"\" height=\"273\" src=\"https://image.prepladder.com/content/SecmgudfRgwYplMFNJmJ1745319033.png\" width=\"244\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Mous A, Hacking C, Campos A\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/supracondylar-humeral-fracture-2\" data-tags=\"\" height=\"285\" src=\"https://image.prepladder.com/content/vkIcI8oExlfM5qE4eqTX1745319028.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"337\" src=\"https://image.prepladder.com/content/eYT9HKESqBIVJb7BcQML1745319021.png\" width=\"337\"/></p>\n<p> </p>\n<ul>\n<li><strong>Fishtail sign: </strong>The ends of the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> fragment are slightly widened and serrated, resembling a fishtail<strong>.</strong></li>\n</ul>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"James Heilman, MD\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Supracondylar_humerus_fracture#/media/File:Supracondylar09.JPG\" data-tags=\"\" height=\"405\" src=\"https://image.prepladder.com/content/S0UoKChAXAi5TSyyJqR11745318996.png\" width=\"348\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Diego Delso\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Common_dentex#/media/File:Dent%C3%B3n_com%C3%BAn_(Dentex_dentex),_franja_marina_Teno-Rasca,_Tenerife,_Espa%C3%B1a,_2022-01-08,_DD,_DD_64.jpg\" data-tags=\"\" height=\"392\" src=\"https://image.prepladder.com/content/I8BEpoRtYEeEsNnFsRiY1745318987.png\" width=\"246\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Crescent sign: </strong>The normal <span class=\"customMeta\" data-dictid=\"17825c11c616927771979bd9b0b285\">radiolucent</span> gap of the <span class=\"customMeta\" data-dictid=\"3fead70a341692777187431ed9d5e0\">elbow joint</span> is replaced by a crescent-shaped shadow from the <span class=\"customMeta\" data-dictid=\"2f2b8ee27316927771830e8372cc12\">capitulum</span> overlapping the olecranon, indicating <span class=\"customMeta\" data-dictid=\"5cdf29eaf516927772012b4a16cde1\">varus</span> or <span class=\"customMeta\" data-dictid=\"e33d939e82169277720167f59b0ee2\">valgus</span> tilt of the <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> fragment.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Leonardo Lustosa\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/supracondylar-fracture-gartland-type-i-2\" data-tags=\"\" height=\"328\" src=\"https://image.prepladder.com/content/EERfIMY2ZsJWTRPXNRS31745318959.png\" width=\"251\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Based on the type of fracture</p>\n<ul>\n<li><strong>Undisplaced fracture: </strong>Immobilisation in above-elbow <span class=\"customMeta\" data-dictid=\"6c22f2390016927771955c0c04b851\">plaster</span> slab with the elbow in 90-degree flexion.</li>\n<li><strong>Displaced fractures</strong>\n<ul>\n<li>Closed reduction with <span class=\"customMeta\" data-dictid=\"b2fb1a3a5416927771953ea4fa15e1\">percutaneous</span> K-wire fixation. (for Type 2 fracture)</li>\n<li>Open reduction internal <span class=\"customMeta\" data-dictid=\"71fd4297541692777202797b7596b9\">fixation</span> with K-wire. (for Type 3 fracture)</li>\n</ul>\n</li>\n<li><strong>In Late presentation with swelling</strong>\n<ul>\n<li>Dunlop <span class=\"customMeta\" data-dictid=\"66d1f5d3461692777200af5741a710\">traction</span> (skin)</li>\n<li>Smith <span class=\"customMeta\" data-dictid=\"66d1f5d3461692777200af5741a710\">traction</span> (skeletal)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Early complications</strong>\n<ul>\n<li>Vascular injury (commonly Brachial artery)</li>\n<li>Nerve injury (commonly <strong>Anterior Interosseous nerve</strong>)</li>\n</ul>\n</li>\n<li><strong>Delayed complications</strong>\n<ul>\n<li><strong>Cubitus <span class=\"customMeta\" data-dictid=\"5cdf29eaf516927772012b4a16cde1\">varus</span> or Gunstock <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> (Malunion) (Option C)</strong></li>\n<li>Volkmann's Ischemia and <span class=\"customMeta\" data-dictid=\"ce3edddb5116927771844c030f3c1e\">compartment</span> syndrome.</li>\n<li>Elbow stiffness</li>\n<li>Myositis ossificans.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child with a history of recurrent respiratory infections presented with complaints of pain around the knee along with high fever. X – ray shows lytic and sclerotic bone. His peripheral blood smear is shown in the image below. The organism most likely involved is?", "options": [{"label": "A", "text": "Staphylococcus aureus", "correct": false}, {"label": "B", "text": "Escherichia", "correct": false}, {"label": "C", "text": "Salmonella", "correct": true}, {"label": "D", "text": "Streptococcus", "correct": false}], "correct_answer": "C. Salmonella", "question_images": ["https://image.prepladder.com/notes/jUAgzcnZiZXZE7zsRRqB1746274327.png", "https://image.prepladder.com/notes/8wT1JHtK7oO1ISOTOska1746274394.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A boy falls on the left shoulder joint and presents to the emergency department with shoulder pain. His left elbow is flexed and is supported by the right hand. Which bone might be most likely fractured?", "options": [{"label": "A", "text": "Clavicle", "correct": true}, {"label": "B", "text": "Scapula", "correct": false}, {"label": "C", "text": "Humerus", "correct": false}, {"label": "D", "text": "Rib cage", "correct": false}], "correct_answer": "A. Clavicle", "question_images": ["https://image.prepladder.com/content/UmfVkUJgfeDSRIeSYlfR1745319938.png"], "explanation_images": ["https://image.prepladder.com/content/pWNJ3PvP2YhjZuypvmWz1745320019.png", "https://image.prepladder.com/notes/zpIZPfFBQpME8EV8OTfZ1746274530.png", "https://image.prepladder.com/notes/gpUmPY52mnGgnDKhxn0V1746274597.png", "https://image.prepladder.com/notes/VTlGoTPHsEisEneLUuJv1746274639.png", "https://image.prepladder.com/notes/jgGt3V4iv4NdyUU7iyLR1746274703.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "DNA packing is done by which of the following?", "options": [{"label": "A", "text": "Histone", "correct": true}, {"label": "B", "text": "Glycoprotein", "correct": false}, {"label": "C", "text": "Nucleus acid", "correct": false}, {"label": "D", "text": "Adenine", "correct": false}], "correct_answer": "A. Histone", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Core Histones: H2A, H2B, H3, and H4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Linker Histone: H1</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>These histones are highly conserved across species, indicating their essential role in <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> processes.</li>\n<li>The core histones <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> the <span class=\"customMeta\" data-dictid=\"c04e3370101692777193c443d503fb\">nucleosome</span> by creating a <span class=\"customMeta\" data-dictid=\"2f9fcbc0831692777189f689777d4f\">histone</span> octamer around which DNA is wrapped.</li>\n<li>The carboxyl-terminal two-thirds of the <span class=\"customMeta\" data-dictid=\"2f9fcbc0831692777189f689777d4f\">histone</span> molecules are hydrophobic, while the amino-terminal thirds are rich in basic <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acids.</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>H1 is the least tightly <span class=\"customMeta\" data-dictid=\"d82fcb9d1f16927771836a9f6ccf14\">bound</span> to <span class=\"customMeta\" data-dictid=\"77399c6ee0169277718492fb8fd58f\">chromatin</span> and can be easily removed with a salt solution, making <span class=\"customMeta\" data-dictid=\"77399c6ee0169277718492fb8fd58f\">chromatin</span> more soluble.</li>\n<li>H1 interacts with DNA as it enters and exits the nucleosome, playing a role in the higher-order structure of chromatin.</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<h4><strong>Histone Octamer</strong></h4>\n<p>The <span class=\"customMeta\" data-dictid=\"2f9fcbc0831692777189f689777d4f\">histone</span> octamer is the fundamental unit of the <span class=\"customMeta\" data-dictid=\"c04e3370101692777193c443d503fb\">nucleosome</span> and consists of eight <span class=\"customMeta\" data-dictid=\"2f9fcbc0831692777189f689777d4f\">histone</span> molecules:</p>\n<ul>\n<li>Two molecules each of H2A, H2B, H3, and H4.</li>\n<li>These histones interact specifically to <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> a structure with the composition (H3–H4)₂–(H2A–H2B)₂.</li>\n<li>H3 and H4 <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> a <span class=\"customMeta\" data-dictid=\"937a5135311692777200d1da979c99\">tetramer</span> (H3–H4)₂, and H2A and H2B <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> dimers (H2A–H2B).</li>\n<li>This octamer binds approximately 145-150 base pairs of DNA, creating 1.75 superhelical turns around it.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient who hails from Mediterranean country and travels to Africa, they contact malaria. After receiving treatment with primaquine, the patient subsequently develops haemolytic anaemia. Which pathway deficiency in the enzyme could potentially be responsible for this condition?", "options": [{"label": "A", "text": "Glycolysis", "correct": false}, {"label": "B", "text": "Gluconeogenesis", "correct": false}, {"label": "C", "text": "Hexose monophosphate (HMP) pathway", "correct": true}, {"label": "D", "text": "Luebering-Rapoport pathway", "correct": false}], "correct_answer": "C. Hexose monophosphate (HMP) pathway", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the subsequent disorders, exhibit only autosomal recessive inheritance pattern?", "options": [{"label": "A", "text": "Huntington’s disease", "correct": false}, {"label": "B", "text": "Treacher collins syndrome", "correct": false}, {"label": "C", "text": "Cystic fibrosis", "correct": true}, {"label": "D", "text": "Achondroplasia", "correct": false}], "correct_answer": "C. Cystic fibrosis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Autosomal Dominant</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Autosomal Recessive</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Huntington’s disease (<strong>Option A</strong>)</li>\n<li>Marfan syndrome</li>\n<li>Achondroplasia (<strong>Option D</strong>)</li>\n<li>Familial hypercholesterolemia</li>\n<li>Neurofibromatosis type 1</li>\n<li>Polycystic <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease (ADPKD)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Cystic <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> (<strong>Option C</strong>)</li>\n<li>Sickle cell anemia</li>\n<li>Tay-Sachs disease</li>\n<li>Phenylketonuria (PKU)</li>\n<li>Thalassemia</li>\n<li>Albinism,Wilson’s disease</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the options aids in the transportation of fatty acids through the inner mitochondria membrane?", "options": [{"label": "A", "text": "Acyl carrier protein", "correct": false}, {"label": "B", "text": "Carnitine", "correct": true}, {"label": "C", "text": "Lecithin-Cholesterol acyltransferase", "correct": false}, {"label": "D", "text": "Albumin", "correct": false}], "correct_answer": "B. Carnitine", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the term for a single mutation in a nucleotide base pair that leads to formation of termination codon?", "options": [{"label": "A", "text": "Missense mutation", "correct": false}, {"label": "B", "text": "Nonsense mutation", "correct": true}, {"label": "C", "text": "Stop mutation", "correct": false}, {"label": "D", "text": "Silent mutation", "correct": false}], "correct_answer": "B. Nonsense mutation", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/EMHqN5UTjNTxH2DbcRVd1745322813.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Based on the Effects on <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">Amino</span> acid sequence</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Silent <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">Mutation</span> (Option D) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Missense <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">Mutation</span> (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Nonsense <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">Mutation</span> (Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Mutation may change the <span class=\"customMeta\" data-dictid=\"3faf36c69716927771840561232eaa\">codon</span> for <strong>one <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acid to a synonym for the same <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acid.</strong></li>\n<li>It has no effect on the phenotype.</li>\n<li>Degeneracy of the code.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Different <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acid</strong> is incorporated due to change in the <span class=\"customMeta\" data-dictid=\"94a2f0970016927771932885a3d362\">nucleotide</span> sequence.</li>\n<li>It can be acceptable, partially acceptable, and unacceptable.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Codon for an <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> acid is mutated to a <strong>termination codon</strong> (UAA or UGA or UAG) causing <span class=\"customMeta\" data-dictid=\"84f13673191692777196762b18e036\">premature</span> <span class=\"customMeta\" data-dictid=\"a35c217ec416927772009a7f3b20f4\">termination</span> of translation.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which enzyme deficiency could potentially be the cause of exercise intolerance and cramps in adolescent male patient?", "options": [{"label": "A", "text": "Myophosphorylase", "correct": true}, {"label": "B", "text": "Hexokinase", "correct": false}, {"label": "C", "text": "Glucose-6-phosphatase", "correct": false}, {"label": "D", "text": "Hepatic glycogen phosphorylase", "correct": false}], "correct_answer": "A. Myophosphorylase", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following enzyme activities can be estimated in red blood cells to diagnose vitamin B2 deficiency?", "options": [{"label": "A", "text": "Transketolase", "correct": false}, {"label": "B", "text": "Glutathione reductase", "correct": true}, {"label": "C", "text": "Kynureninase", "correct": false}, {"label": "D", "text": "Pyruvate dehydrogenase", "correct": false}], "correct_answer": "B. Glutathione reductase", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the mask in the image used for patients with COVID-19 infection.", "options": [{"label": "A", "text": "Venturi mask", "correct": false}, {"label": "B", "text": "Hudson mask", "correct": false}, {"label": "C", "text": "Nebuliser", "correct": false}, {"label": "D", "text": "Non-rebreathing mask", "correct": true}], "correct_answer": "D. Non-rebreathing mask", "question_images": ["https://image.prepladder.com/content/0lLceCzFnto5iWBxsC721745322989.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the cause of following condition due to?", "options": [{"label": "A", "text": "Vitamin C", "correct": false}, {"label": "B", "text": "Vitamin A", "correct": true}, {"label": "C", "text": "Vitamin B", "correct": false}, {"label": "D", "text": "Vitamin E", "correct": false}], "correct_answer": "B. Vitamin A", "question_images": ["https://image.prepladder.com/content/aOem1jMCWPukXcUc6vzH1745323091.png"], "explanation_images": ["https://image.prepladder.com/content/RlzgRUC8ak9v7INdNxeU1745323170.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:476px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>XN</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Night blindness.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>X1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>X1A: Conjunctival xerosis.</li>\n<li>X1B: Bitot spots.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>X2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Corneal xerosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>X3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>X3A: Corneal ulceration, less than one-third.</li>\n<li>X3B: Corneal ulceration, more than one-third.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>XS</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Corneal scar.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>XF</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Xerophthalmic fundus.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p><strong>References:</strong></p>\n<ul><li>↳ Harper Edition 32, Page no: 538</li><li>↳ Lippincott Edition 7, page no:1112,1113</li><li>↳ Vasudevan Edition 7, page no: 467,468</li><li>↳ Image reference: Kanski’s Ophthalmology Edition 9, page no:247</li></u\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The image given below shows neuromuscular monitoring of the patient after anesthesia. What is the most commonly used nerve for monitoring?", "options": [{"label": "A", "text": "Ulnar nerve", "correct": true}, {"label": "B", "text": "Median nerve", "correct": false}, {"label": "C", "text": "Radial nerve", "correct": false}, {"label": "D", "text": "Metacarpal nerve", "correct": false}], "correct_answer": "A. Ulnar nerve", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the enzyme defect if a child with anemia, thrombocytopenia, bony pain and hepatosplenomegaly shows a \"crumpled tissue paper\" appearance on light microscopy of bone marrow aspirate?", "options": [{"label": "A", "text": "Beta- glucosidase", "correct": true}, {"label": "B", "text": "Sphingomyelinase", "correct": false}, {"label": "C", "text": "Hexosaminidase", "correct": false}, {"label": "D", "text": "Glucose6-phosphatase", "correct": false}], "correct_answer": "A. Beta- glucosidase", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/UkE3EMbEappG2hpBiUmt1745323310.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "According to triage, which of the following categories of patients comes under green?", "options": [{"label": "A", "text": "Ambulatory patients", "correct": true}, {"label": "B", "text": "Moderate priority", "correct": false}, {"label": "C", "text": "High Priority", "correct": false}, {"label": "D", "text": "Dead patients", "correct": false}], "correct_answer": "A. Ambulatory patients", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:638px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Colour </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Priority </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Medical Need </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical Status </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Examples </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Red </strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>First</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Immediate</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Critical, but likely to survive if treatment is given early</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Severe <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> trauma</li>\n<li>Tension pneumothorax</li>\n<li>Profuse external bleeding</li>\n<li>Haemothorax</li>\n<li>Flail chest</li>\n<li>Major <span class=\"customMeta\" data-dictid=\"b02812a466169277719090c2d27868\">intra-abdominal</span> bleed</li>\n<li>Extradural haematomas</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Yellow </strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Second</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Urgent</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Critical, but likely to survive if treatment is given within hours</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Compound fractures</li>\n<li>Degloving injuries</li>\n<li>Ruptured <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> viscus</li>\n<li>Pelvic fracture</li>\n<li>Spinal injuries</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Green </strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Third</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Non-Urgent</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Stable, likely to survive even if treatment is delayed for hours to days</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Simple fractures</li>\n<li>Sprains</li>\n<li>Minor lacerations</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Black </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Last</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Unsalvageable</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Not breathing, pulseless, so severely injured that no medical care is likely to help.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Severe brain damage</li>\n<li>Very extensive burns</li>\n<li>Major disruption/ loss of chest or <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall structures</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following substances inhibits cytochrome complex IV, a component of the electron transport chain responsible for ATP synthesis?", "options": [{"label": "A", "text": "Cyanide", "correct": true}, {"label": "B", "text": "Carbon dioxide", "correct": false}, {"label": "C", "text": "Oligomycin", "correct": false}, {"label": "D", "text": "Ouabain", "correct": false}], "correct_answer": "A. Cyanide", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Microfilariae with a sheathed tail and two nuclei at the tail is suggestive of?", "options": [{"label": "A", "text": "Wuchereria bancrofti", "correct": false}, {"label": "B", "text": "Brugia malayi", "correct": true}, {"label": "C", "text": "Loa loa", "correct": false}, {"label": "D", "text": "Onchocerca volvulus", "correct": false}], "correct_answer": "B. Brugia malayi", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/JTi0wGezK70LcoUcJ8Tx1746258826.png", "https://image.prepladder.com/notes/wAfh1s1aI0JcPEKjy1qW1746258927.png", "https://image.prepladder.com/notes/f6DmDvz69Qnl3UoaB2bD1746258964.png", "https://image.prepladder.com/notes/yKHERQcHDyeYApOpJI7q1746258991.png", "https://image.prepladder.com/notes/zZNUP3D1bwgX9Ch3lFwI1746259041.png", "https://image.prepladder.com/notes/r4PU4tfeBDS1mXtTp9uH1746259068.png", "https://image.prepladder.com/notes/2rlBSFY6uydBoL3rtnSM1746259098.png", "https://image.prepladder.com/notes/puPELqvFx8gEftrKfCcF1746259127.png", "https://image.prepladder.com/notes/WBgkrs8H5HwLElZsJvIm1746259154.png", "https://image.prepladder.com/notes/KlyYpbWyDXcP8m9eehNp1746259476.png", "https://image.prepladder.com/notes/y1q4ZDGnQcI7zBGtSQOR1746259502.png", "https://image.prepladder.com/notes/WnVD7BCqZQD78w17YhoY1746259526.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Species </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Wuchereria bancrofti (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Brugia malayi (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Loa loa</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mansonella perstans </strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mansonella ozzardi</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Onchocerca volvulus</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Shape </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><img alt=\"Wuchereria bancrofti A\" data-author=\"\" data-hash=\"11582\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/JTi0wGezK70LcoUcJ8Tx1746258826.png\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><img alt=\"Brugia malayi \" data-author=\"\" data-hash=\"11583\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/wAfh1s1aI0JcPEKjy1qW1746258927.png\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><img alt=\"Loa loa\" data-author=\"\" data-hash=\"11584\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/f6DmDvz69Qnl3UoaB2bD1746258964.png\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><img alt=\"Mansonella perstans \" data-author=\"\" data-hash=\"11585\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/yKHERQcHDyeYApOpJI7q1746258991.png\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><img alt=\"Mansonella ozzardi\" data-author=\"\" data-hash=\"11586\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/zZNUP3D1bwgX9Ch3lFwI1746259041.png\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><img alt=\"Onchocerca volvulus\" data-author=\"\" data-hash=\"11587\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/r4PU4tfeBDS1mXtTp9uH1746259068.png\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Posterior end </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><img alt=\"Wuchereria bancrofti B\" data-author=\"\" data-hash=\"11588\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/2rlBSFY6uydBoL3rtnSM1746259098.png\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><img alt=\"Brugia malayi B\" data-author=\"\" data-hash=\"11589\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/puPELqvFx8gEftrKfCcF1746259127.png\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><img alt=\"Loa loa\" data-author=\"\" data-hash=\"11590\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/WBgkrs8H5HwLElZsJvIm1746259154.png\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><img alt=\"Mansonella perstans B\" data-author=\"\" data-hash=\"11591\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/KlyYpbWyDXcP8m9eehNp1746259476.png\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><img alt=\"Mansonella ozzardi\" data-author=\"\" data-hash=\"11592\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/y1q4ZDGnQcI7zBGtSQOR1746259502.png\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><img alt=\"Onchocerca volvulus\" data-author=\"\" data-hash=\"11593\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/WnVD7BCqZQD78w17YhoY1746259526.png\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tail nuclei</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Nuclei do not extend to the tip of the tail</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2 <span class=\"customMeta\" data-dictid=\"e6b47028191692777193eb698e43b6\">nuclei</span> at the tip of the tail</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Nuclei <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> continuous rows in the tip of the tail</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Nuclei extend to the tip of the tail</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Nuclei do not extend to the tip of the tail</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Nuclei do not extend to the tip of the tail</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sheath </strong></p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sheathed</p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Unsheathed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Periodicity </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Nocturnal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Nocturnal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Diurnal</p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Nonperiodic</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Primary <span class=\"customMeta\" data-dictid=\"1f7e7543bc16927772015cdb525c2b\">Vector</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Culex, Anopheles, Aedes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mansonia spp., Anopheles</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Chrysops spp.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Simulium spp.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Culicoides</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Culicoides</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A photographer who recently returned from Africa presents to the emergency department with abdominal pain, hepatomegaly, and hemorrhagic manifestations. He died despite treatment, and an autopsy revealed intranuclear Torres bodies in the liver. Which of the following vaccines with which strain could have prevented it?", "options": [{"label": "A", "text": "17D", "correct": true}, {"label": "B", "text": "Nakayama vaccine", "correct": false}, {"label": "C", "text": "Weigl’s vaccine", "correct": false}, {"label": "D", "text": "Jeryl Lynn strain", "correct": false}], "correct_answer": "A. 17D", "question_images": [], "explanation_images": [], "explanation": "<table align=\"left\" cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Yellow fever</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Agent and Vector</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Flavivirus transmitted primarily by mosquitoes\n\t\t\t\t<ul>\n<li><strong>Aedes <span class=\"customMeta\" data-dictid=\"8fad75f63f1692777192f93996c6ab\">Mosquito</span> (in urban settings)</strong></li>\n<li>Haemagogus (in jungle or forested areas)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hosts</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Primarily monkeys (Reservoir hosts)</li>\n<li>Humans are (Incidental hosts) and can develop severe disease.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Environmental Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Found in tropical and subtropical areas of Africa and South America, where <span class=\"customMeta\" data-dictid=\"8fad75f63f1692777192f93996c6ab\">mosquito</span> vectors are prevalent.</li>\n<li>Transmission occurs primarily in forested or jungle areas.</li>\n<li>Typical Conditions:</li>\n<li>Temperature: 24-36’C</li>\n<li>Humidity: &gt;60%</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Initial symptoms (acute phase, 3-6 days post-infection): fever, chills, headache, backache, muscle aches, loss of appetite.</li>\n<li>Severe cases (toxic phase): jaundice, bleeding, organ <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> (liver, kidney).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Based on clinical signs</li>\n<li><strong>Travel history to <span class=\"customMeta\" data-dictid=\"59c8c1e4b316927771873c98afae15\">endemic</span> areas</strong></li>\n<li>Confirmed by <span class=\"customMeta\" data-dictid=\"723fdec66b1692777186e92f0c6fdf\">detection</span> of YFV <span class=\"customMeta\" data-dictid=\"cc65bdc03f169277719726a675e8a7\">RNA</span> or specific antibodies (IgM and IgG) in blood samples.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Live-attenuated vaccine (17D strain)</strong></li>\n<li>Diluent: lyophilized (freeze-dried) powder with <span class=\"customMeta\" data-dictid=\"894da1dfe6169277719871d7210619\">saline</span> solution.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 5-year-old child presents with reduced hearing for the past 2-3 months. The otoscopy finding is given below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Myringitis bullosa", "correct": false}, {"label": "B", "text": "Serous otitis media", "correct": true}, {"label": "C", "text": "Acute otitis media", "correct": false}, {"label": "D", "text": "Pneumo Tympanum", "correct": false}], "correct_answer": "B. Serous otitis media", "question_images": ["https://image.prepladder.com/content/lnMQMAz6mktYkGlR6VHe1745324182.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Symptoms</strong></p>\n<p> </p>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><u>Hearing Loss</u>: Conductive, mild to moderate (20-40 dB), gradual onset, may fluctuate; children may not complain, but parents may notice difficulties in hearing.</li>\n<li>Delayed/Defective Speech</li>\n<li>Mild Earaches</li>\n<li>Fullness in Ear.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Signs </strong></p>\n<p> </p>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><u>Tympanic <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">Membrane</span> Appearance</u>: Dull, opaque, possibly yellow, grey, or bluish; absence of the usual light reflex.</li>\n<li><u>Visible Fluid/Bubbles: </u>Air-fluid levels or bubbles visible behind the eardrum.</li>\n<li><u>Retracted <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">Tympanic</span> Membrane</u>: Negative <span class=\"customMeta\" data-dictid=\"d7879d301d169277719255fe8818dc\">middle ear</span> pressure causing <span class=\"customMeta\" data-dictid=\"78dedc93bb16927771864ef7301f3a\">eardrum</span> retraction, with the <span class=\"customMeta\" data-dictid=\"d90238772d169277719102f03b90eb\">malleus</span> handle appearing shortened or horizontal.</li>\n<li>Reduced <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">Tympanic</span> <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">Membrane</span> Mobility.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Rinne Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>In <span class=\"customMeta\" data-dictid=\"672584d0ee16927771858886c9eb14\">conductive hearing loss</span> (SOM), <span class=\"customMeta\" data-dictid=\"b295cd96751692777183939f64ff6e\">bone conduction</span> is better than <span class=\"customMeta\" data-dictid=\"c6b732e83416927771812e15b4586c\">air conduction</span> (negative Rinne test).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Weber Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>In <span class=\"customMeta\" data-dictid=\"672584d0ee16927771858886c9eb14\">conductive hearing loss</span> (SOM), the sound is louder in the affected ear when the <span class=\"customMeta\" data-dictid=\"201cac2bd016927772015dfc0f600c\">tuning fork</span> is placed on the forehead.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Absolute <span class=\"customMeta\" data-dictid=\"b295cd96751692777183939f64ff6e\">Bone Conduction</span> (ABC) Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Both patient and examiner hear the <span class=\"customMeta\" data-dictid=\"201cac2bd016927772015dfc0f600c\">tuning fork</span> for a similar duration when placed on the <span class=\"customMeta\" data-dictid=\"a59fda103116927771912d5d76d293\">mastoid</span> bone (ear canals plugged) in <span class=\"customMeta\" data-dictid=\"672584d0ee16927771858886c9eb14\">conductive hearing loss</span> (SOM). (Bone <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> not impaired)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Schwabach's Test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>In <span class=\"customMeta\" data-dictid=\"672584d0ee16927771858886c9eb14\">conductive hearing loss</span> (SOM), the patient hears the <span class=\"customMeta\" data-dictid=\"201cac2bd016927772015dfc0f600c\">tuning fork</span> for a longer duration than the examiner when placed on the <span class=\"customMeta\" data-dictid=\"a59fda103116927771912d5d76d293\">mastoid</span> bone (ear canals not plugged).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pneumatic Otoscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Visualizes <span class=\"customMeta\" data-dictid=\"78dedc93bb16927771864ef7301f3a\">eardrum</span> movement with air pressure changes; reduced/absent movement indicates fluid presence.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Impedance audiometry</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Measures <span class=\"customMeta\" data-dictid=\"78dedc93bb16927771864ef7301f3a\">eardrum</span> movement; typically shows a flat/dome-shaped curve with negative pressure, indicating <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> compliance.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Audiometry</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Conductive <span class=\"customMeta\" data-dictid=\"f3f80e5bee1692777188f6eb1c4005\">hearing loss</span> (20-40 dB).</li>\n<li>Sometimes, associated <span class=\"customMeta\" data-dictid=\"a646a25d3616927771989c6e155498\">sensorineural</span> <span class=\"customMeta\" data-dictid=\"f3f80e5bee1692777188f6eb1c4005\">hearing loss</span> (d/t fluid on the <span class=\"customMeta\" data-dictid=\"ae3483b8c91692777197c75b7af9a9\">round window</span> membrane.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>X-ray/CT Scan of Temporal Bone</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>May show <span class=\"customMeta\" data-dictid=\"a59fda103116927771912d5d76d293\">mastoid</span> air cell <span class=\"customMeta\" data-dictid=\"54df5d069d1692777184d80f7b1a7f\">clouding</span> due to fluid</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old man with a known case of hypertension presented with multiple episodes of hematuria and loin pain. His elder brother passed away due to a stroke at the age of 40. The CT abdomen is shown below. What is the probable diagnosis?", "options": [{"label": "A", "text": "Renal cell carcinoma", "correct": false}, {"label": "B", "text": "Autosomal dominant polycystic kidney disease", "correct": true}, {"label": "C", "text": "Tuberculosis of the kidney", "correct": false}, {"label": "D", "text": "Autosomal recessive polycystic kidney disease", "correct": false}], "correct_answer": "B. Autosomal dominant polycystic kidney disease", "question_images": ["https://image.prepladder.com/notes/OfkTGMGYRW9NjPSAsRBZ1746428155.png"], "explanation_images": ["https://image.prepladder.com/notes/0U47GiAVJwhwv9oL6OOV1746428221.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:608px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Autosomal dominant <span class=\"customMeta\" data-dictid=\"ba336eb30516927771960f9d9bd85c\">polycystic</span> <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Characterised by the growth of numerous cysts in the kidneys.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Inheritance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Autosomal Dominant</li>\n<li>Involvement of <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> 16 <strong>(PKD1)</strong> and 4 <strong>(PKD2)</strong></li>\n<li>Abnormal protein-<strong>Polycystin</strong></li>\n<li>Both kidneys are replaced by multiple cysts</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features (Intrarenal)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Most common manifestation</strong> is hypertension</li>\n<li>Polyuria, Nocturia, Hematuria</li>\n<li>Nephrolithiasis</li>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure (Usually in the 5th to 6th decade)</li>\n<li>Any <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> in the <span class=\"customMeta\" data-dictid=\"3cc82f8bfb1692777195602cfccef5\">pelvicalyceal</span> system will lead to HIS (Hydronephrosis; Infection; Stone) → Hematuria</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features (Extrarenal)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Polycystic Liver Disease <strong>(Most common) </strong></li>\n<li>Cyst in Ovary, Pancreas, Spleen Berry Aneurysm</li>\n<li>Mitral Valve prolapse</li>\n<li>The most common <span class=\"customMeta\" data-dictid=\"254dc5106d1692777183ba9ab1b3e5\">cause of death</span> is <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> Disorders</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Investigation of choice:</strong> CECT</li>\n<li><strong>Ultrasound: </strong>Confirms the presence of cysts</li>\n<li><strong>IVP (Intravenous Pyelogram):</strong>\n<ul>\n<li>Spider leg/Bell-shaped appearance</li>\n<li>Bubble appearance</li>\n<li>Swiss-cheese appearance</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li><strong>Blood <span class=\"customMeta\" data-dictid=\"38d4be106e169277720105b006c26b\">urea</span> and <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> creatinine</strong>: Elevated</li>\n<li><strong>Urine:</strong> Shows low specific gravity</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Wait and watch initially.</strong> Surgical intervention is required only after cysts get overdistended, causing pain, hemorrhage, and infection.</li>\n<li><strong>Gold Standard:</strong> <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> Transplantation</li>\n<li><strong>Rovsing's Operation:</strong> Deroofing of <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">Cyst</span> in ADPKD. The <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> is exposed. The <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> is opened. The fluid is evacuated.</li>\n<li>US-guided <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> &amp; Laparoscopic <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> is commonly done as a simpler approach.</li>\n<li>Once <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure sets in, initial <span class=\"customMeta\" data-dictid=\"6ba3fb0ce51692777188eaf7843351\">hemodialysis</span> followed by <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> <span class=\"customMeta\" data-dictid=\"26983fde4e16927771933da7b06ff9\">nephrectomy</span> is done, and later <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"ee9f07b0a81692777200e416e4e5d7\">transplantation</span> can be planned</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A militant presents with fever and a rash that started on the trunk first and spread to the extremities, sparing palms and soles. On examination, a louse is noted. Which of the following is responsible for his condition?", "options": [{"label": "A", "text": "Rickettsia akari", "correct": false}, {"label": "B", "text": "Rickettsia conorii", "correct": false}, {"label": "C", "text": "Rickettsia prowazekii", "correct": true}, {"label": "D", "text": "Rickettsia typhi", "correct": false}], "correct_answer": "C. Rickettsia prowazekii", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:700px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Epidemic <span class=\"customMeta\" data-dictid=\"2b3121f9de1692777201f8f08c152e\">typhus</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causative agent </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rickettsia prowazekii (It is the only <span class=\"customMeta\" data-dictid=\"b6ba4e2167169277719768a4b1dcf2\">rickettsial</span> disease that can occur as an epidemic)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Vector </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Louse</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>It occurs during conditions favourable to human body <span class=\"customMeta\" data-dictid=\"c6a796b2de16927771913a9977216c\">lice</span> <span class=\"customMeta\" data-dictid=\"97f6c38301169277719097d4d23cff\">infestation</span> such as in <strong>refugee</strong> and<strong> famine camps</strong>.(crowding, infrequent bathing)</li>\n<li>The cycle starts with R.prowazekii circulating in a patient’s blood during an <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"e57922b3c91692777202151895d37e\">febrile</span> infection.</li>\n<li>After <strong>5 to 10 days</strong> of incubation, large numbers of <span class=\"customMeta\" data-dictid=\"afc499591216927771978ad7d8eaae\">rickettsiae</span> appear in its <strong>infective faeces</strong>.</li>\n<li>Since the <span class=\"customMeta\" data-dictid=\"5dacacc82916927771910cd3388165\">louse</span> defecates when it feeds, the organisms can be rubbed into the <span class=\"customMeta\" data-dictid=\"5dacacc82916927771910cd3388165\">louse</span> bite wounds when the host <span class=\"customMeta\" data-dictid=\"5ca3a9c7051692777198d5bd67dd6c\">scratches</span> the site.</li>\n<li><strong>Dried <span class=\"customMeta\" data-dictid=\"5dacacc82916927771910cd3388165\">louse</span> faeces </strong>are also <span class=\"customMeta\" data-dictid=\"aa279cf1f016927771903f195bb1b9\">infectious</span> through the <span class=\"customMeta\" data-dictid=\"26080f047a169277719334625cadef\">mucous</span> membranes of the eye or <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> tract. The <span class=\"customMeta\" data-dictid=\"5dacacc82916927771910cd3388165\">louse</span> dies of its infection in 1 to 3 weeks.</li>\n<li>Most of Rickettsiae, including <span class=\"customMeta\" data-dictid=\"d39294c67d16927771970f0119c9d1\">Rickettsia</span> prowazekii, shows <strong>tropism</strong> for <strong>vascular endothelium</strong>.</li>\n<li>They multiply in the endothelial cells, leading to increased <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> permeability, hypovolemia, and hypotension.</li>\n<li>Focal areas of endothelial <span class=\"customMeta\" data-dictid=\"8eedb6cec61692777196a6a3b93d3f\">proliferation</span> cause the <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> and petechial lesions, <span class=\"customMeta\" data-dictid=\"a606b55b4316927771956c3cb0d383\">perivascular</span> <span class=\"customMeta\" data-dictid=\"669bdcb3111692777190e018ae930e\">infiltration</span> that leads to thrombosis, and leakage of red blood cells into the surrounding tissues.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Fever</strong>, headache, and <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> begin 1 to 2 weeks after the bite.</li>\n<li>In the majority of cases, a <strong>maculopapular <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> appears first on the trunk and then spreads centrifugally to the extremities</strong>, <strong>sparing the palms and soles</strong>.</li>\n<li>Eschar is absent at the site of entry.</li>\n<li>Headache, malaise, and <span class=\"customMeta\" data-dictid=\"0868f47e42169277719358f65df7e6\">myalgia</span> are prominent components of the illness.</li>\n<li>Complications include <strong>myocarditis</strong> and<strong> central nervous system dysfunction.</strong></li>\n<li>In untreated disease, the fatality rate increases with age as much as 60%.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> test of choice is <span class=\"customMeta\" data-dictid=\"6cffb1ffdd1692777198f0c11de8fe\">serology</span> i.e. rise in <span class=\"customMeta\" data-dictid=\"9d7a12cab116927771811a0079086d\">antibody</span> titre.</li>\n<li><strong>Weil-Felix test </strong>showing both <strong>OX 19+</strong> and <strong>OX 2+</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Treatment with <strong>doxycycline</strong> is effective.</li>\n<li><strong>Louse control</strong> is the best means of prevention and is particularly important in controlling epidemics.</li>\n<li>No effective vaccine is available.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old man complained of recurrent discharge and pain due to lesions around the anus for 3 years. What is the diagnosis?", "options": [{"label": "A", "text": "Pilonidal sinus", "correct": false}, {"label": "B", "text": "Carbuncle", "correct": false}, {"label": "C", "text": "Boil", "correct": false}, {"label": "D", "text": "Fistula in ano", "correct": true}], "correct_answer": "D. Fistula in ano", "question_images": ["https://image.prepladder.com/notes/ZvDBaiwN2xXDStJg2eiN1746428331.png"], "explanation_images": ["https://image.prepladder.com/content/WjjIEnuVURMlJ7KfTPuh1745324829.png", "https://image.prepladder.com/content/7e6Tcoj0We1MTGCQV6WC1745324834.png", "https://image.prepladder.com/content/lkWSluHZiWLxwCmDIO4q1745324839.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Fistula in ano</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Idiopathic/Cryptoglandular: The most common cause, often associated with prior <span class=\"customMeta\" data-dictid=\"a5d2b7108116927771811311422c5c\">anorectal</span> sepsis.<strong> </strong></li>\n<li>Associated Conditions:\n\t\t\t\t<ul>\n<li>Crohn’s disease</li>\n<li>Tuberculosis</li>\n<li>Lymphogranuloma venereum</li>\n<li>Actinomycosis</li>\n<li>Rectal duplication</li>\n<li>Foreign bodies</li>\n<li>Malignancy (rare, can develop within a longstanding fistula)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Intermittent <span class=\"customMeta\" data-dictid=\"0c02372a7d1692777196974ab1d772\">purulent</span> discharge: This may be bloody and purulent. Discomfort typically increases until the <span class=\"customMeta\" data-dictid=\"e4626b4cea16927771968e59732fef\">pus</span> discharges, providing temporary relief.</li>\n<li>Previous history of <span class=\"customMeta\" data-dictid=\"a5d2b7108116927771811311422c5c\">Anorectal</span> abscess</li>\n<li>Passage of <span class=\"customMeta\" data-dictid=\"c952bab9c2169277720207dd4f48d0\">flatus</span> or faeces: Through the external opening (indicative of a rectal rather than an anal internal opening).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with itching in the axilla. On microscopic examination of the skin scrapings, a red pigment-producing fungus with pencil-shaped macroconidia is observed. Which of the following is the most likely organism?", "options": [{"label": "A", "text": "Trichophyton mentagrophytes", "correct": false}, {"label": "B", "text": "Trichophyton rubrum", "correct": true}, {"label": "C", "text": "Trichophyton schoenleinii", "correct": false}, {"label": "D", "text": "Trichophyton violaceum", "correct": false}], "correct_answer": "B. Trichophyton rubrum", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Dermatophyte</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Macroscopic Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Microscopic Appearance</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T. rubrum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Velvety, red <span class=\"customMeta\" data-dictid=\"05e2e2617c16927771952bcbeea08b\">pigment</span> on reverse</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Microconidia—tear drop shaped, plenty</p>\n<p>Macroconidia—few, long, pencil-shaped</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T. mentagrophytes (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>White to tan, powdery, <span class=\"customMeta\" data-dictid=\"05e2e2617c16927771952bcbeea08b\">pigment</span> variable</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Microconidia—numerous, round to pyriform</p>\n<p>Macroconidia—cigar-shaped</p>\n<p>Spiral hyphae seen</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T. schoenleinii (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Smooth, waxy</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Microconidia and macroconidia—rare or absent</p>\n<p>Chlamydospores seen</p>\n<p>Hyphae—hyphal <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> and favic chandelier seen</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>T. violaceum (Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Slow growing, waxy, <span class=\"customMeta\" data-dictid=\"3f54b73e011692777202c95e6aea2e\">violet</span> <span class=\"customMeta\" data-dictid=\"05e2e2617c16927771952bcbeea08b\">pigment</span> on reverse</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Microconidia and macroconidia—rare or absent</p>\n<p>Distorted hyphae seen</p>\n<p>Chlamydospores seen</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>M. canis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cottony, orange <span class=\"customMeta\" data-dictid=\"05e2e2617c16927771952bcbeea08b\">pigment</span> on reverse</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Macroconidia—abundant, thick-walled, spiny, spindle-shaped, up to 15 septa, pointed ends</p>\n<p>Microconidia—rare</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>E. floccosum</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Powdery, folded, yellowish-green</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Macroconidia—club or clavate-shaped in clusters, 4–6 septa</p>\n<p>Microconidia—absent</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the structure given in the image.", "options": [{"label": "A", "text": "Malleus", "correct": false}, {"label": "B", "text": "Incus", "correct": true}, {"label": "C", "text": "Stapes", "correct": false}, {"label": "D", "text": "Vomer", "correct": false}], "correct_answer": "B. Incus", "question_images": ["https://image.prepladder.com/notes/7b6fpXzkTvsyxiNRjKez1746257832.png"], "explanation_images": ["https://image.prepladder.com/notes/tgLpneEOvmPLqkzePMRd1746257891.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most frequently occurring location for an intraperitoneal abscess to develop?", "options": [{"label": "A", "text": "Suprahepatic", "correct": false}, {"label": "B", "text": "Subhepatic", "correct": true}, {"label": "C", "text": "Left lobe of the liver", "correct": false}, {"label": "D", "text": "Left side below diaphragm", "correct": false}], "correct_answer": "B. Subhepatic", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female patient presents with thick, curdy white vaginal secretions. Microscopic examination of a vaginal scraping shows budding yeast and pseudohyphae. Which of the following media can be utilized to determine the probable species of the causative agent?", "options": [{"label": "A", "text": "Birds seed agar", "correct": false}, {"label": "B", "text": "Brain heart infusion agar", "correct": false}, {"label": "C", "text": "CHROM agar", "correct": true}, {"label": "D", "text": "SDA", "correct": false}], "correct_answer": "C. CHROM agar", "question_images": ["https://image.prepladder.com/content/8ZAASsi0BWqgOGfpK1ff1747748657.png"], "explanation_images": ["https://image.prepladder.com/notes/VIyGRgmpUKUJOK9Gsr7F1746259676.png", "https://image.prepladder.com/notes/WtWwvvlSHccqdGore4XS1746259737.png", "https://image.prepladder.com/notes/qRMYFyJh57of6hwuLSxC1746259794.png", "https://image.prepladder.com/notes/dRRQVeKOAxdR3JaVgeXN1746259860.png", "https://image.prepladder.com/notes/dUni718bqL17qVpWe6Ez1746259941.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Laboratory diagnosis of candida</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Germ tube test</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"b3623bc67216927771889eb144d9ed\">germ</span> tube test is a specific <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> test for <span class=\"customMeta\" data-dictid=\"f54d5c5cf11692777183318f259e5f\">Candida</span> albicans.</li>\n<li>Germ tube also seen in <span class=\"customMeta\" data-dictid=\"f54d5c5cf11692777183318f259e5f\">candida</span> dubliniensis</li>\n<li>Candida tropicalis- pseudo <span class=\"customMeta\" data-dictid=\"b3623bc67216927771889eb144d9ed\">germ</span> tube formation</li>\n</ul>\n<p> </p>\n<p>Also known as <strong>Reynolds Braude Phenomenon</strong></p>\n<p>Candida + Human <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> → Incubation → Big tube-like structure (Pseudohyphae).</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Germ tube test\" data-author=\"Ajay Kumar Chaurasiya\" data-hash=\"11594\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Mannitol_salt_agar_(MSA)_with_growth_of_S._aureus,_CoNS_and_no_growth_of_E._coli.jpg\" data-tags=\"May2025\" height=\"307\" src=\"https://image.prepladder.com/notes/VIyGRgmpUKUJOK9Gsr7F1746259676.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gram stain</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Yeast-like organism - Has both buds and pseudohyphae.</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Gram stain candida\" data-author=\"Graham Beards\" data-hash=\"11595\" data-license=\"CC BY SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Candida_Gram_stain.jpg\" data-tags=\"May2025\" height=\"268\" src=\"https://image.prepladder.com/notes/WtWwvvlSHccqdGore4XS1746259737.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>SDA Culture media test (Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Colonies are creamy white, smooth and with a yeasty odor</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"SDA Culture media test\" data-author=\"Ajay Kumar Chaurasiya\" data-hash=\"11596\" data-license=\"CCO\" data-source=\"https://commons.wikimedia.org/wiki/File:Candida_albicans_colony_morphology_on_Sabouraud_dextrose_agar_(SDA).jpg\" data-tags=\"May2025\" height=\"395\" src=\"https://image.prepladder.com/notes/qRMYFyJh57of6hwuLSxC1746259794.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Corn meal <span class=\"customMeta\" data-dictid=\"2c294889fb169277718046e4ef230c\">agar</span> test</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Forms <strong>chlamydospores</strong> on corn meal <span class=\"customMeta\" data-dictid=\"2c294889fb169277718046e4ef230c\">agar</span> cultures at 20°C -identified by double wall configuration.</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Corn meal agar test\" data-author=\"Radoslaw Spiewak\" data-hash=\"11597\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/Microscopy-of-Candida-albicans-growing-on-corn-meal-agar-Courtesy-of-Dr-Michael-R_fig9_13426624\" data-tags=\"May2025\" height=\"256\" src=\"https://image.prepladder.com/notes/dRRQVeKOAxdR3JaVgeXN1746259860.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Chrom <span class=\"customMeta\" data-dictid=\"2c294889fb169277718046e4ef230c\">agar</span> test (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Colour <span class=\"customMeta\" data-dictid=\"55a682d72e16927771865bb4855ba3\">differentiation</span> test</p>\n<p>Each type of organism is seen differently</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Chrom agar test\" data-author=\"Mikael Häggström\" data-hash=\"11598\" data-license=\"CC0\" data-source=\"https://commons.wikimedia.org/wiki/File:CHROMAgar_with_N_glabratus,_P_kudriavzevii,_Candida_albicans_and_Candida_tropicalis,_annotated.jpg\" data-tags=\"May2025\" height=\"283\" src=\"https://image.prepladder.com/notes/dUni718bqL17qVpWe6Ez1746259941.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old post-COVID male patient came with complaints of one-sided facial swelling, headache, and nasal sinus congestion. He is diabetic and it is uncontrolled. On examination black lesions on the nasal bridge and upper inside of the mouth were observed. Which investigation would you do to confirm the diagnosis of this patient?", "options": [{"label": "A", "text": "X-ray", "correct": false}, {"label": "B", "text": "Biopsy with histopathologic examination", "correct": true}, {"label": "C", "text": "Serum ferritin", "correct": false}, {"label": "D", "text": "HbA1c", "correct": false}], "correct_answer": "B. Biopsy with histopathologic examination", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\">\n<tbody>\n<tr>\n<td colspan=\"2\">\n<p><strong>Mucormycosis</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Description</strong></p>\n</td>\n<td>\n<p>A severe fungal infection primarily affects the nose and sinuses but can quickly spread to the orbit, <span class=\"customMeta\" data-dictid=\"978aa37443169277718555206ddf9e\">cribriform</span> plate, meninges, and brain. The <span class=\"customMeta\" data-dictid=\"618e9d3b6416927772031d0260310e\">fungus</span> invades arteries, causing endothelial damage, thrombosis, and rapid tissue destruction.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Characteristic Findings</strong></p>\n</td>\n<td>\n<p>Black necrotic material in the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> cavity, eroding the <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> septum, hard palate, and turbinates. <strong>Black <span class=\"customMeta\" data-dictid=\"0715afec83169277720196fd982691\">turbinate</span> sign</strong> is seen on contrast enhanced MRI.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Risk Factors</strong></p>\n</td>\n<td>\n<ul>\n<li>Uncontrolled diabetes, especially with ketoacidosis</li>\n<li>Prolonged <span class=\"customMeta\" data-dictid=\"a48ce797cd1692777199efc43b3e4c\">steroid</span> use (common in <span class=\"customMeta\" data-dictid=\"2d364aeaf7169277718529fa58f6ea\">COVID-19</span> treatment)</li>\n<li>Conditions causing immunosuppression: Neutropenia, HIV/AIDS, chemotherapy, organ transplants, and <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> issues.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Diagnosis</strong></p>\n</td>\n<td>\n<ul>\n<li><strong>Endoscopy:</strong> Shows pale <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> early, progressing to black crusts and sloughing.</li>\n<li><strong>Biopsy:</strong> Multiple sites should be sampled for fungal identification; <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> <span class=\"customMeta\" data-dictid=\"0a57b1bc5916927771895a4f4e60b4\">hydroxide</span> preparation is the <strong>gold standard</strong><strong> </strong>for confirming <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> features.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Imaging</strong></p>\n</td>\n<td>\n<ul>\n<li><strong>CT</strong>: Detects bony destruction and initial assessment of <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> involvement.</li>\n<li><strong>CECT: </strong>CECT provides better delineation of soft tissue structures, allowing for <span class=\"customMeta\" data-dictid=\"55436411c216927771846e318f45ce\">clearer</span> identification of mucosal thickening, <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> opacification, and bony destruction.</li>\n<li><strong>MRI</strong>: Evaluates soft tissue invasion, assesses the extent of extra-sinus disease, and identifies complications, especially in the <strong>orbit and brain</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Treatment</strong></p>\n</td>\n<td>\n<p><strong>Antifungal Therapy</strong>:</p>\n<ul>\n<li>Amphotericin B: 0.6 to 1 mg/kg/day IV or liposomal Amphotericin B: 5 mg/kg/day.</li>\n<li>Posaconazole: 300 mg twice daily orally on the first day, then 300 mg once daily.</li>\n</ul>\n<p><strong>Surgical Intervention</strong>:</p>\n<ul>\n<li>Endoscopic debridement of necrotic tissues.</li>\n<li>Severe cases: Total/Partial <span class=\"customMeta\" data-dictid=\"7e1612510d1692777192cfe698ecc1\">maxillectomy</span> or <span class=\"customMeta\" data-dictid=\"bfe6beb7131692777194500ac5f2d2\">orbital</span> <span class=\"customMeta\" data-dictid=\"b26b12affb16927771872ba42c137b\">exenteration</span> may be required.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which nerve is most likely to be affected in a patient who complains of an inability to close the eye, drooling of saliva, and deviation of the angle of the mouth?", "options": [{"label": "A", "text": "Facial nerve", "correct": true}, {"label": "B", "text": "Trigeminal nerve", "correct": false}, {"label": "C", "text": "Oculomotor nerve", "correct": false}, {"label": "D", "text": "Glossopharyngeal nerve", "correct": false}], "correct_answer": "A. Facial nerve", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/8iXXL03hGiqslSqKHdiH1746258000.png"], "explanation": "<p>Correct Option A) &lt;span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\"&gt;Facial&lt;/span&gt; nerv\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 12-year-old boy presents with right upper quadrant pain, calf pain, conjunctival suffusion, icterus, and fever. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Chikungunya", "correct": false}, {"label": "B", "text": "Dengue hemorrhagic fever", "correct": false}, {"label": "C", "text": "Encephalopathy caused by hepatitis A", "correct": false}, {"label": "D", "text": "Leptospirosis", "correct": true}], "correct_answer": "D. Leptospirosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/AB4PTTZKmuLGfoFGng5L1746260346.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:687px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Leptospirosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Agent</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Leptospira interrogans (zoonotic bacteria)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reservoir</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Rodents</strong> (Ratus norvegicus, <span class=\"customMeta\" data-dictid=\"18fd5724dc169277719319473a650b\">Mus</span> musculus) and domestic animals</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Source</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Direct contact or <span class=\"customMeta\" data-dictid=\"22b9188ade169277718581ce9dc589\">contamination</span> with <strong>excreta, <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> of infected animals.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>At risk individuals</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Males 20-45 years (most common)</li>\n<li>Urine-contaminated mud(Soil) or water\n\t\t\t\t<ul>\n<li>Sports: rafting, fishing and swimming</li>\n<li>Rice field workers, sewer workers, animal handlers</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mode of transmission</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Direct contact: <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">Urine</span> through skin abrasion</li>\n<li>Indirect contact: Contact of broken skin with soil, water, vegetation</li>\n<li>Droplet infection: <span class=\"customMeta\" data-dictid=\"0b1500fcd816927771900b59d16bde\">Inhalation</span> while <span class=\"customMeta\" data-dictid=\"5930026faa1692777192fce0743bff\">milking</span> cows.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Incubation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>4-20 days</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Fever with chills</li>\n<li><strong>Headache &amp; retro-orbital pain</strong></li>\n<li><strong>Conjunctival <span class=\"customMeta\" data-dictid=\"961c0c601416927771993e2c4dfa19\">suffusion</span> </strong></li>\n<li><strong>Myalgia </strong></li>\n<li><strong>Nausea, vomiting, diarrhea</strong></li>\n<li>Non-specific rash</li>\n</ul>\n<p> </p>\n<ul>\n<li><strong>Anicteric leptospirosis:</strong></li>\n<li>Milder form</li>\n<li>Pulmonary manifestations are primary concern</li>\n<li><strong>Icteric leptospirosis: </strong></li>\n<li>More severe form</li>\n<li>Jaundice, fever, <span class=\"customMeta\" data-dictid=\"0868f47e42169277719358f65df7e6\">myalgia</span> hypotension,</li>\n<li>Circulatory failure</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Diagnosis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Dark Field examination: </strong>Thin and <span class=\"customMeta\" data-dictid=\"27cf09e9d316927771928763e99e0d\">motile</span> <strong>spirochete</strong>.</li>\n<li>IgM <strong>ELISA</strong>: High sensitivity</li>\n<li>Labs: Elevated liver enzymes, increased <strong>bilirubin</strong>, <strong>thrombocytopenia</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A newly joined teacher develops rice-water stools. The causative agent acts on which of the following receptors?", "options": [{"label": "A", "text": "Cerebroganglioside", "correct": false}, {"label": "B", "text": "GM2 ganglioside receptor", "correct": false}, {"label": "C", "text": "GM1 ganglioside receptor", "correct": true}, {"label": "D", "text": "Sphingomyelin", "correct": false}], "correct_answer": "C. GM1 ganglioside receptor", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with cisplatin-induced nausea and vomiting was managed with an antiemetic, after which he developed symptoms like acute dystonia, bradykinesia, and tremors. Which of the following drugs would have caused these symptoms?", "options": [{"label": "A", "text": "Ondansetron", "correct": false}, {"label": "B", "text": "Metoclopramide", "correct": true}, {"label": "C", "text": "Meclizine", "correct": false}, {"label": "D", "text": "Scopolamine", "correct": false}], "correct_answer": "B. Metoclopramide", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is considered to be the best for the detection of Clostridium difficile?", "options": [{"label": "A", "text": "Aerobic culture of stool", "correct": false}, {"label": "B", "text": "Toxin assay", "correct": true}, {"label": "C", "text": "Glutamate dehydrogenase assay", "correct": false}, {"label": "D", "text": "Colonoscopy", "correct": false}], "correct_answer": "B. Toxin assay", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/7H4V2OymPOsPUwUYVSR31746260474.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:572px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:1px solid #1f1f1f; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Diagnosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p><strong>Colonoscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:none; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<ul>\n<li>Examination of the <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> whitish-yellow plaques on the <span class=\"customMeta\" data-dictid=\"566fcef0991692777184068f36db82\">colonic</span> <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> known as microabscesses.</li>\n<li>Although it is highly specific, it is not as sensitive as ELISA, hence it is not considered the Gold standard for diagnosis. <strong>(Option D ruled out)</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Pseudomembranous colitis 01\" data-author=\"Klinikum Dritter Orden, München. Abteilung Innere Medizin\" data-hash=\"11600\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Pseudomembranoese_Colitis_Endo3.jpg\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/7H4V2OymPOsPUwUYVSR31746260474.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p><strong>Culture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:none; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<ul>\n<li>Stool samples cultured on selective media to identify C. difficile;<strong> less sensitive than <span class=\"customMeta\" data-dictid=\"41329dc9381692777200a9b6d57cf4\">toxin</span> detection. (Option A ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p><strong>Toxin Detection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:none; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>ELISA: Detects toxins A and/or B in <span class=\"customMeta\" data-dictid=\"44335bb8bf1692777199a956cb31bf\">stool</span> samples, the gold standard (Option B).</strong></li>\n<li>Cell Culture: Toxins produce characteristic effects on Hep-2 or human <span class=\"customMeta\" data-dictid=\"52d06e3e001692777186400050f388\">diploid</span> cell cultures, neutralized by C. sordellii antitoxin.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p><strong>Molecular Methods</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:none; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<ul>\n<li>PCR: Detects genes coding for toxins A and B in <span class=\"customMeta\" data-dictid=\"44335bb8bf1692777199a956cb31bf\">stool</span> samples.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p><strong>Histopathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:none; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<ul>\n<li>This can be performed with <span class=\"customMeta\" data-dictid=\"1cbb322f2c1692777188d48b3e3ef7\">hematoxylin</span> and <span class=\"customMeta\" data-dictid=\"2379e628e2169277718790981be825\">eosin</span> stains</li>\n<li>Highly specific but low sensitivity</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p>Antibiotic Discontinuation</p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:none; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<ul>\n<li>Stop the <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> suspected of contributing to the infection.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p>Antibiotic Therapy</p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:none; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<ul>\n<li>Oral vancomycin or metronidazole.</li>\n<li>Severe cases: Combination of oral vancomycin, <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> metronidazole, and rectal vancomycin enemas.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Prevention</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p>Antibiotic Stewardship</p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:none; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<ul>\n<li>Limit the use of <span class=\"customMeta\" data-dictid=\"583de7632e16927771834054d1be58\">broad-spectrum</span> antibiotics like clindamycin, ampicillin, and fluoroquinolones; prevent <span class=\"customMeta\" data-dictid=\"5744dac7511692777186db6f8e0c28\">disruption</span> of normal gut flora.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p>Infection Control Measures</p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:none; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<ul>\n<li>Meticulous hand <span class=\"customMeta\" data-dictid=\"15fa752a4f1692777189fe275abf3f\">hygiene</span> and <span class=\"customMeta\" data-dictid=\"3cad0eb1921692777185d0a7b642fc\">contact precautions</span> in healthcare settings.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Recent Treatment Option</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:1px solid #1f1f1f; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<p>Fecal Transplants</p>\n</td>\n<td style=\"border-bottom:1px solid #1f1f1f; border-left:none; border-right:1px solid #1f1f1f; border-top:none; vertical-align:top\">\n<ul>\n<li>Replenishing gut <span class=\"customMeta\" data-dictid=\"0af84af4761692777202fbf6914573\">flora</span> with donated faeces from screened healthy donor</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A truck driver with diabetes visits you complaining of cough and difficulty breathing. Pneumonia has been diagnosed, and histopathological examination indicates the presence of nonseptate hyphae branching at wide angles. What is the probable cause of this condition?", "options": [{"label": "A", "text": "Cryptococcus neoformans", "correct": false}, {"label": "B", "text": "Mucor", "correct": true}, {"label": "C", "text": "Candida", "correct": false}, {"label": "D", "text": "Aspergillus", "correct": false}], "correct_answer": "B. Mucor", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/EGJY3Pk3JMX9Xp43b4C21746260709.png", "https://image.prepladder.com/notes/awePfB2T6yMreKtcMn8T1746260882.png", "https://image.prepladder.com/notes/Al8mbHwXf8QpBvJ5Iq5S1746268770.png", "https://image.prepladder.com/notes/sC1M9UEBHzHKtuORAkEj1746268847.png", "https://image.prepladder.com/notes/LNWKLwN7rrCjNZ6lQJjZ1746268914.png", "https://image.prepladder.com/notes/BMnhlLTcBcO4LqtwxNgg1746268996.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Mucormycosis</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is an <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> disease caused by zygomycetes (phycomycetes) - <strong>Rhizopus, <span class=\"customMeta\" data-dictid=\"2cd8f411371692777193c9fa32b32c\">Mucor</span> and Absidia</strong>. <strong>Rhizopus Arrhizus </strong>is the most common pathogen</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Structure of Rhizopus\" data-author=\"Timleo\" data-hash=\"11601\" data-license=\"OPEN ACCESS\" data-source=\"https://en.wikipedia.org/wiki/Rhizopus\" data-tags=\"May2025\" height=\"315\" src=\"https://image.prepladder.com/notes/EGJY3Pk3JMX9Xp43b4C21746260709.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>Rhizopus</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Absidia\" data-author=\" CDC/Dr. Lucille K. Georg \" data-hash=\"11602\" data-license=\"OPEN ACCESS\" data-source=\"https://en.wikipedia.org/wiki/Absidia\" data-tags=\"May2025\" height=\"274\" src=\"https://image.prepladder.com/notes/awePfB2T6yMreKtcMn8T1746260882.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Mucor\" data-author=\" Alison Burkett, M.D., Sawanan Saitornuang, B.S., Sixto M. Leal, Jr., M.D., Ph.D.\" data-hash=\"11605\" data-license=\"NA\" data-source=\"https://www.pathologyoutlines.com/topic/microbiologyzygomycetes.html\" data-tags=\"May2025\" height=\"226\" src=\"https://image.prepladder.com/notes/Al8mbHwXf8QpBvJ5Iq5S1746268770.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>Absidia</strong> <strong>Mucor</strong> (Lactophenol cotton blue stained)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Begins in the <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> or <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> cavity, where spores germinate and <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> mycelia → invade adjacent tissues, leading to local destruction.</p>\n<p>Fungi invade blood vessels, causing <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> and <span class=\"customMeta\" data-dictid=\"77aed446d2169277719007f42bf052\">infarction</span> in affected areas, which contributes to its high mortality rate (Angio-invasiveness)</p>\n<p><strong>Common Sites</strong></p>\n<ul>\n<li><strong>Rhinocerebral Form</strong>: Involves the nose, <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> sinuses, and orbit; frequently seen in <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">diabetic</span> patients.</li>\n<li><strong>Pulmonary Infections</strong>: When the lungs are the primary site, the <span class=\"customMeta\" data-dictid=\"5ab0081e8316927772037e0f7c5a79\">fungi</span> can invade lung arteries, leading to serious complications.</li>\n<li>Others: Cutaneous mucormycosis, GI mucormycosis, Disseminated mucormycosis</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<h3><strong>Clinical Features</strong></h3>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Rhinocerebral Zygomycosis</strong>:\n\t\t\t\t<ul>\n<li>Facial swelling, <strong>nasal discharge</strong> (often <strong>black</strong>), fever, and <strong>mucosal necrosis</strong>.</li>\n<li>Rapid <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> can lead to severe complications, including visual loss and neurological symptoms.</li>\n</ul>\n</li>\n<li><strong>Pulmonary Zygomycosis</strong>:\n\t\t\t\t<ul>\n<li>Symptoms may include cough, fever, and <strong>hemoptysis</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histological Examination</strong>:</p>\n<p>Diagnosis is confirmed by identifying broad, non-septate (or sparsely septate) hyphae.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\" Rhizopus 01\" data-author=\"Mohan B Sannathimmappa Vinod Nambiar Rajeev Aravindhakshan\" data-hash=\"11606\" data-license=\"CC BY-NC-SA 4.0\" data-source=\"https://www.researchgate.net/figure/Common-diagnostic-features-of-Rhizopus-species-a-Growth-of-Rhizopus-spp-on-Saborauds_fig1_359443745\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/sC1M9UEBHzHKtuORAkEj1746268847.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>Culture: </strong></p>\n<ul>\n<li>After <span class=\"customMeta\" data-dictid=\"78e661328b1692777190280365ea89\">incubation</span> for 3-4 days on Sabouraud <span class=\"customMeta\" data-dictid=\"2c294889fb169277718046e4ef230c\">agar</span> at 30-37°C, the colonies are grey-white with a thick cottony, fluffy surface.</li>\n<li>Under the microscope, nonseptate, broad hyphae with aerial sporangiophores which end in a <span class=\"customMeta\" data-dictid=\"7234e0b4e11692777199d188770525\">sporangium</span> (a <span class=\"customMeta\" data-dictid=\"59ae5630de16927771988a866d1dea\">sac</span> containing spores are seen.)</li>\n</ul>\n<p><strong>a</strong>. </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\" Sabourauds dextrose agar\" data-author=\"Mohan B Sannathimmappa Vinod Nambiar Rajeev Aravindhakshan\" data-hash=\"11607\" data-license=\"CC BY-NC-SA 4.0\" data-source=\"https://www.researchgate.net/figure/Common-diagnostic-features-of-Rhizopus-species-a-Growth-of-Rhizopus-spp-on-Saborauds_fig1_359443745\" data-tags=\"May2025\" height=\"350\" src=\"https://image.prepladder.com/notes/LNWKLwN7rrCjNZ6lQJjZ1746268914.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>b</strong>.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Microscopy of LPCB stained preparation\" data-author=\"Mohan B Sannathimmappa Vinod Nambiar Rajeev Aravindhakshan\" data-hash=\"11608\" data-license=\"CC BY-NC-SA 4.0\" data-source=\"https://www.researchgate.net/figure/Common-diagnostic-features-of-Rhizopus-species-a-Growth-of-Rhizopus-spp-on-Saborauds_fig1_359443745\" data-tags=\"May2025\" height=\"310\" src=\"https://image.prepladder.com/notes/BMnhlLTcBcO4LqtwxNgg1746268996.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>a. Sabouraud's <span class=\"customMeta\" data-dictid=\"baf8b019b01692777186c856f83721\">dextrose</span> <span class=\"customMeta\" data-dictid=\"2c294889fb169277718046e4ef230c\">agar</span> (SDA) medium showing Rhizopus growth </strong></p>\n<p><strong>b. Microscopy of LPCB stained preparation demonstrating <span class=\"customMeta\" data-dictid=\"2dcf62bc831692777192e737f2c4b0\">morphology</span> of Rhizopus spp. (non-septate hyphae, sporangiophore, <span class=\"customMeta\" data-dictid=\"7234e0b4e11692777199d188770525\">sporangium</span> and spores)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Intravenous amphotericin B combined, where appropriate, with <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> is the recommended treatment.</li>\n<li>Medical control of diabetes is required.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A woman who was prescribed a broad-spectrum antibiotic presents with recurrent diarrhea. Regarding Clostridium difficile infection, which of the following statements is false?", "options": [{"label": "A", "text": "Oral fidaxomicin is used for treatment", "correct": false}, {"label": "B", "text": "It is toxin-mediated", "correct": false}, {"label": "C", "text": "No risk of fulminant infection", "correct": true}, {"label": "D", "text": "Pseudomembrane is a layer of inflammatory cells and debris", "correct": false}], "correct_answer": "C. No risk of fulminant infection", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:616px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Definition</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Inflammatory condition of the <span class=\"customMeta\" data-dictid=\"0fce15e71f1692777184feb9af5303\">colon</span> caused by <span class=\"customMeta\" data-dictid=\"27791cc8181692777184b363360a3c\">Clostridium</span> difficile <span class=\"customMeta\" data-dictid=\"41329dc9381692777200a9b6d57cf4\">toxin</span> production, leading to <span class=\"customMeta\" data-dictid=\"a952f661da169277719691c48c8cbe\">pseudomembrane</span> formation on the <span class=\"customMeta\" data-dictid=\"566fcef0991692777184068f36db82\">colonic</span> mucosa.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Etiology</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Primarily caused by C. difficile infection, usually after <span class=\"customMeta\" data-dictid=\"583de7632e16927771834054d1be58\">broad-spectrum</span> <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> use (e.g., clindamycin, fluoroquinolones, cephalosporins).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Risk Factors</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Recent <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> use</li>\n<li>Hospitalization</li>\n<li>Elderly patients</li>\n<li>Immunosuppression (e.g., chemotherapy, organ transplant)</li>\n<li>Proton pump inhibitors (PPIs)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pathogenesis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>C. difficile produces <span class=\"customMeta\" data-dictid=\"41329dc9381692777200a9b6d57cf4\">Toxin</span> A (enterotoxin) and <span class=\"customMeta\" data-dictid=\"41329dc9381692777200a9b6d57cf4\">Toxin</span> B (cytotoxin), leading to mucosal damage, inflammation, and <span class=\"customMeta\" data-dictid=\"a952f661da169277719691c48c8cbe\">pseudomembrane</span> formation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clinical Features</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Watery <span class=\"customMeta\" data-dictid=\"aaabe672c51692777186a829ebdc0c\">diarrhea</span> (non-bloody)</li>\n<li>Abdominal pain and cramping</li>\n<li>Fever</li>\n<li>Leukocytosis</li>\n<li>Severe cases: Toxic megacolon, perforation, <span class=\"customMeta\" data-dictid=\"39f67d7dde16927771985d3952058d\">septic</span> shock</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Endoscopic Findings</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Yellow-white plaques on the <span class=\"customMeta\" data-dictid=\"566fcef0991692777184068f36db82\">colonic</span> <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> (pseudomembranes)</li>\n<li>Patchy or <span class=\"customMeta\" data-dictid=\"8793eea96e169277718446e2ea701a\">confluent</span> distribution</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Diagnosis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Stool <span class=\"customMeta\" data-dictid=\"41329dc9381692777200a9b6d57cf4\">toxin</span> <span class=\"customMeta\" data-dictid=\"fc026ff6d81692777182835f6de6df\">assay</span> (Toxin A &amp; B <span class=\"customMeta\" data-dictid=\"3e4873f1941692777187410ddeb16a\">ELISA</span> or PCR) - Gold standard.</li>\n<li>Glutamate <span class=\"customMeta\" data-dictid=\"0d1ed86c771692777185d6b762efd5\">dehydrogenase</span> (GDH) assay</li>\n<li>Colonoscopy/Sigmoidoscopy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Treatment</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>First-line: Oral vancomycin or fidaxomicin</li>\n<li>Alternative: Oral metronidazole</li>\n<li>Severe/Recurrent cases: Fecal <span class=\"customMeta\" data-dictid=\"ee4913785d16927771929d78b794c7\">microbiota</span> transplantation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Complications</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Fulminant colitis</strong></li>\n<li>Toxic megacolon</li>\n<li>Intestinal perforation</li>\n<li>Sepsis &amp; Multi-organ failure</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An adult man in a restaurant suddenly begins choking on his food. He is conscious. The following procedure was performed. Identify the procedure.", "options": [{"label": "A", "text": "Heimlich’s maneuver", "correct": true}, {"label": "B", "text": "Back slap", "correct": false}, {"label": "C", "text": "Chest thrust", "correct": false}, {"label": "D", "text": "Blind insertion of finger", "correct": false}], "correct_answer": "A. Heimlich’s maneuver", "question_images": ["https://image.prepladder.com/content/ymze8YwKBNzd3ZqmLXiH1745327055.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young patient started to take a weight loss medication that acts by inhibiting fat absorption from food. After a few weeks, she developed increased menstrual bleeding and stool that sticks to the pan. Which of the following vitamins is responsible for her deficiency?", "options": [{"label": "A", "text": "Vitamin E", "correct": false}, {"label": "B", "text": "Vitamin K", "correct": true}, {"label": "C", "text": "Vitamin B6", "correct": false}, {"label": "D", "text": "Vitamin D", "correct": false}], "correct_answer": "B. Vitamin K", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A diabetic patient presented with rhinitis and facial swelling. An intranasal biopsy revealed the presence of broad-based aseptate hyphae with branching at the right angle. Evidence of vascular invasion was present. What will be the drug of choice", "options": [{"label": "A", "text": "Fluconazole", "correct": false}, {"label": "B", "text": "Amphotericin B", "correct": true}, {"label": "C", "text": "Ketoconazole", "correct": false}, {"label": "D", "text": "Griseofluvin", "correct": false}], "correct_answer": "B. Amphotericin B", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Amphotericin B</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of Action</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Binds to <strong>ergosterol in fungal cell membranes</strong><strong>,</strong> forming pores that disrupt <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> integrity, leading to leakage of <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> contents and fungal cell death.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Preparation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Conventional <span class=\"customMeta\" data-dictid=\"2aca559df7169277718182de664e44\">Amphotericin B</span> (c-AMB)</li>\n<li>Amphotericin B <span class=\"customMeta\" data-dictid=\"a99114a6c216927771916f45ffc66c\">lipid</span> complex (ABLC)</li>\n<li><strong>Liposomal <span class=\"customMeta\" data-dictid=\"2aca559df7169277718182de664e44\">Amphotericin B</span> (L-AMB)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Use</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cryptococcal meningitis</strong>, mucormycosis, <span class=\"customMeta\" data-dictid=\"2e83427a461692777184438dd9af19\">coccidioidal</span> meningitis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Adverse Effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Nephrotoxicity</strong><strong>:</strong> Most notable with conventional <span class=\"customMeta\" data-dictid=\"2aca559df7169277718182de664e44\">Amphotericin B</span> (c-AMB); less with liposomal formulations</li>\n<li>Fever, chills, and <span class=\"customMeta\" data-dictid=\"9402185d4b1692777189cb62891ff1\">hypotension</span> can be managed with pre-treatment (NSAIDs, antihistamines)</li>\n<li>Anaemia (requires <span class=\"customMeta\" data-dictid=\"ec50ec51401692777187009530441d\">erythropoietin</span> treatment)</li>\n<li><strong>Renal <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> acidosis</strong> leads to <span class=\"customMeta\" data-dictid=\"2e0552462e16927771871413861fb7\">electrolyte</span> imbalances (hypomagnesemia, hypokalemia)</li>\n<li>Arachnoiditis, when used intrathecally</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A male patient with chronic obstructive pulmonary disease (COPD) was prescribed theophylline. He noticed that his urine output had increased the following day. Which of the following receptors is this action of the drug-mediated?", "options": [{"label": "A", "text": "Interleukin - 10", "correct": false}, {"label": "B", "text": "Histone deacetylase", "correct": false}, {"label": "C", "text": "Adenosine A1", "correct": true}, {"label": "D", "text": "Beta 2 adrenergic receptors", "correct": false}], "correct_answer": "C. Adenosine A1", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/vBa6OrvTOLHUrDlsfIfG1745328578.png"], "explanation": "\n<p><strong>Educational Objective:</strong></p>\n<ul><li>➤ Learning Objective:</li><li>➤ Adenosine A1 receptors are found in the kidneys and are involved in regulating water and electrolyte balance. By blocking adenosine A1 receptors, theophylline can lead to increased urine production and diuresis.</li><li>➤ Adenosine A1 receptors are found in the kidneys and are involved in regulating water and electrolyte balance. By blocking adenosine A1 receptors, theophylline can lead to increased urine production and diuresis.</li></u\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following drugs is not likely to cause Pulmonary fibrosis?", "options": [{"label": "A", "text": "Metformin", "correct": true}, {"label": "B", "text": "Methysergide", "correct": false}, {"label": "C", "text": "Bleomycin", "correct": false}, {"label": "D", "text": "Nitrofurantoin", "correct": false}], "correct_answer": "A. Metformin", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/uC02zuUAoB6SqxBsebw21746425842.png", "https://image.prepladder.com/notes/MYsy4ozHCiSE7o12yB6o1746425883.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Side effects and complications of Metformin</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><br/>\n<br/>\n\t\t\t \n\t\t\t<p><strong>Side effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Nausea/Vomiting/Diarrhoea</li>\n<li>Megaloblastic anaemia: reduces vitamin B12 <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> from GIT</li>\n<li>Lactic acidosis\n\t\t\t\t<ul>\n<li>Avoid metformin in COPD, CHF, dehydration, and <span class=\"customMeta\" data-dictid=\"fe9ab8afe416927771980091186846\">sepsis</span> (hypoxia increases <span class=\"customMeta\" data-dictid=\"b82539c9ae1692777191a3f7ddd7bb\">lactic</span> acid production).</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"><br/>\n<br/>\n<br/>\n<br/>\n<br/>\n<br/>\n<br/>\n<br/>\n<br/>\n\t\t\t \n\t\t\t<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Renal failure</strong> is common with metformin use.</li>\n<li>Plasma metformin levels are inversely related to GFR due to <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> drug clearance.</li>\n<li>Current guidelines suggest the safe use of metformin when GFR is more than 30 mL/min/1.73 m<sup>2</sup>.</li>\n<li>Management:\n\t\t\t\t<ul>\n<li>Assess <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> function before starting metformin and monitor it annually.</li>\n<li>Discontinue if <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> &gt;1.5 mg/dL or eGFR <strong>&lt; 30 mL/min/1.73 m</strong><strong><sup>2</sup></strong><strong>.</strong></li>\n<li>Discontinue pre-emptively before radiographic procedures using contrast dyes (till 48 hours after the procedure until <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> function normalises) and <span class=\"customMeta\" data-dictid=\"277d6f3ee2169277718938e321258f\">hospitalization</span> for severe illness (sepsis).</li>\n<li>Dose adjustment is needed for cationic drugs excreted by <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> secretion, such as cimetidine, furosemide, nifedipine, etc.</li>\n<li>It is indicated in patients with severe <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> disease, heart failure, liver disease, or chronic alcohol abuse.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The average life expectancy for a woman in Japan is 87 years. Due to recent advances in testing for cervical cancer, there is an increase in life expectancy by 15 years. The healthcare utility value is 0.8. Which of the following can be calculated from the parameters given?", "options": [{"label": "A", "text": "HALE", "correct": false}, {"label": "B", "text": "DALY", "correct": false}, {"label": "C", "text": "DFLE", "correct": false}, {"label": "D", "text": "QALY", "correct": true}], "correct_answer": "D. QALY", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - QALY (Quality-Adjusted Life Year)\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In an urban area in the state of Madhya Pradesh, a primigravida goes for institutional delivery after being motivated by an ASHA worker. What are the benefits they will receive (in terms of money in rupees) under the Janani Suraksha Yojana?", "options": [{"label": "A", "text": "1000 for mother and 400 for ASHA", "correct": true}, {"label": "B", "text": "1400 for mother and 600 for ASHA", "correct": false}, {"label": "C", "text": "600 for mother and 400 for ASHA", "correct": false}, {"label": "D", "text": "400 for mother and 600 for ASHA", "correct": false}], "correct_answer": "A. 1000 for mother and 400 for ASHA", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - 1000 for mother and 400 for &lt;span class=\"customMeta\" data-dictid=\"817804153a16927771822a30e05c60\"&gt;ASHA&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "As a medical professional at a primary health center (PHC) located in a region prone to frequent seismic activities, what measures would you take to ensure preparedness in the event of an emergency? 1. Disaster preparedness by making sure all financial and other resources are available 2. Increase public awareness through campaigns and loudspeakers 3. Conduct a simulation for the disaster and assess the response 4. Follow instructions given over the phone or radio by higher officials", "options": [{"label": "A", "text": "1,2,3,4", "correct": false}, {"label": "B", "text": "2,3,4", "correct": false}, {"label": "C", "text": "1,2,3", "correct": true}, {"label": "D", "text": "1,2,4", "correct": false}], "correct_answer": "C. 1,2,3", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - 1,2,3\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Although many animals are implicated in the spread of rabies, dogs are the most common ones. Also, it usually affects children in developing countries. Knowing this, what is the most cost-effective and logical way to reduce the incidence of rabies?", "options": [{"label": "A", "text": "Testing all the dogs for rabies", "correct": false}, {"label": "B", "text": "Reduce stray dog population and vaccinate all dogs", "correct": true}, {"label": "C", "text": "Increase the laboratory facilities", "correct": false}, {"label": "D", "text": "Increase capacity of healthcare workers for surveillance", "correct": false}], "correct_answer": "B. Reduce stray dog population and vaccinate all dogs", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - Reduce stray dog population and &lt;span class=\"customMeta\" data-dictid=\"25d0db637516927772019da4d7b8f7\"&gt;vaccinate&lt;/span&gt; all dog\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following steps is excluded from the STEP approach of the World Health Organization (WHO)?", "options": [{"label": "A", "text": "Therapeutic assessment", "correct": true}, {"label": "B", "text": "Physical assessment", "correct": false}, {"label": "C", "text": "Psychological assessment", "correct": false}, {"label": "D", "text": "Behavioral assessment", "correct": false}], "correct_answer": "A. Therapeutic assessment", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - &lt;span class=\"customMeta\" data-dictid=\"8dfaeedbf91692777200561b2b1d2f\"&gt;Therapeutic&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "After undergoing full treatment for tuberculosis, a male patient received sputum examination at the end of both the intensive and continuation phases. The results revealed a negative outcome. What can be concluded about the patient's condition?", "options": [{"label": "A", "text": "Cured", "correct": true}, {"label": "B", "text": "Treatment completed", "correct": false}, {"label": "C", "text": "Lost to follow up", "correct": false}, {"label": "D", "text": "Treatment failed", "correct": false}], "correct_answer": "A. Cured", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - Cu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements accurately describes the findings of a cohort study examining the impact of green tea consumption on diabetes mellitus risk? The study revealed a risk ratio of 0.84 between drinkers and non-drinkers of green tea.", "options": [{"label": "A", "text": "Green tea reduces the risk of diabetes", "correct": true}, {"label": "B", "text": "Green tea increases the risk of diabetes", "correct": false}, {"label": "C", "text": "Data insufficient to establish causal association", "correct": false}, {"label": "D", "text": "The value (0.85) tends to be close to 1, hence there is no effect", "correct": false}], "correct_answer": "A. Green tea reduces the risk of diabetes", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - Green tea reduces the risk\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which statement most accurately describes the criteria for initiating an urban community health center?", "options": [{"label": "A", "text": "Caters to a population of 1-1.5 lakh", "correct": false}, {"label": "B", "text": "Referral center for 2-3 primary health centers", "correct": false}, {"label": "C", "text": "No sub-district and district hospitals present in the area", "correct": false}, {"label": "D", "text": "Should have a 100-bed facility in metro cities", "correct": true}], "correct_answer": "D. Should have a 100-bed facility in metro cities", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - Should hav\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "According to biomedical waste management protocols, what is the proper method of disposing of a broken vaccine vial?", "options": [{"label": "A", "text": "Puncture proof blue bin", "correct": true}, {"label": "B", "text": "White container", "correct": false}, {"label": "C", "text": "Yellow container", "correct": false}, {"label": "D", "text": "Red Bag", "correct": false}], "correct_answer": "A. Puncture proof blue bin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - &lt;span class=\"customMeta\" data-dictid=\"9af4bb5919169277719688aaf3f8e7\"&gt;Puncture&lt;/span&gt; proof blu\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Color</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type of waste</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Example of waste</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment and disposal</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Yellow</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Human <span class=\"customMeta\" data-dictid=\"116f86834a1692777181a914379270\">anatomical</span> waste.</li>\n<li>Animal <span class=\"customMeta\" data-dictid=\"116f86834a1692777181a914379270\">anatomical</span> waste.</li>\n<li>Soiled waste.</li>\n<li>Discarded or expired medicine.</li>\n<li>Microbiology, <span class=\"customMeta\" data-dictid=\"177a32fb7f1692777183fcc83ba413\">biotechnology</span> and other <span class=\"customMeta\" data-dictid=\"3ec60edb4a16927771842bb9fd9aa4\">clinical laboratory</span> waste.</li>\n<li>Chemical waste.</li>\n<li>Chemical liquid waste.</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Placenta.</li>\n<li>Post-operative body parts.</li>\n<li>Plaster of Paris (POP).</li>\n<li>Pathological waste.</li>\n<li>Cotton waste.</li>\n<li>Dressing materials.</li>\n<li>Beddings.</li>\n<li>Body fluid contaminated paper and cloth.</li>\n<li>Face mask, cap, shoe cover and head cover.</li>\n<li>Cytotoxic, expired and discarded medicines.</li>\n<li>Microbiology and <span class=\"customMeta\" data-dictid=\"177a32fb7f1692777183fcc83ba413\">biotechnology</span> lab waste.</li>\n<li>Blood bag</li>\n<li>Vacutainers with blood</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Incineration.</li>\n<li>Plasma pyrolysis.</li>\n<li>Deep burial.</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Red</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Contaminated waste that is recyclable.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Syringe without needles.</li>\n</ul>\n<ul>\n<li>Fixed needle syringes with their needle cut.</li>\n<li>IV set.</li>\n<li>Catheters.</li>\n<li>Gloves (soiled or unsoiled).</li>\n<li>Urine bag.</li>\n<li>Dialysis kit.</li>\n<li>IV bottles.</li>\n<li>Tubing's.</li>\n<li>Bottles.</li>\n<li>Vacutainers with needle cuts.</li>\n<li>Vacutainers without blood.</li>\n<li>ELISA plates and vials not containing blood samples.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Autoclaving or microwaving/ hydroclaving followed by shredding or <span class=\"customMeta\" data-dictid=\"07bda0bb4f1692777193a54fe56f9c\">mutilation</span> and waste set to registered recyclers or for energy recovery/road making.</li>\n</ul>\n<ul>\n<li>Plastic waste should not be sent to landfill sites.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>White</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Waste Sharps</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Needles</li>\n<li>Syringes with fixed needles</li>\n<li>Blades</li>\n<li>Scalpers</li>\n<li>Trocar cannula</li>\n<li>Insulin pen needle</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Puncture proof , Leak proof, Tamper proof containers</li>\n<li>Autoclaving or <span class=\"customMeta\" data-dictid=\"2d95ddf7b8169277718654aee27077\">dry heat</span> <span class=\"customMeta\" data-dictid=\"f39be0f0871692777199459d86e0a7\">sterilization</span> followed by shredding or <span class=\"customMeta\" data-dictid=\"07bda0bb4f1692777193a54fe56f9c\">mutilation</span> or <span class=\"customMeta\" data-dictid=\"5a7f7caa7716927771870658b1c5cf\">encapsulation</span> in metal container or <span class=\"customMeta\" data-dictid=\"d8691a48a91692777184708a8f2f0c\">cement</span> concrete</li>\n<li>Or sent for final disposal to iron foundries or <span class=\"customMeta\" data-dictid=\"601fb1538a16927771987048f6e712\">sanitary</span> landfills or designated concrete waste sharp pit</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Blue</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Glassware or <span class=\"customMeta\" data-dictid=\"84433cae211692777192a484f539bc\">metallic</span> body implants.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Includes broken or discarded glass and <span class=\"customMeta\" data-dictid=\"84433cae211692777192a484f539bc\">metallic</span> objects that are contaminated.</li>\n<li>Glass:\n\t\t\t\t<ul>\n<li>Broken glass.</li>\n<li>Ampoules.</li>\n<li>Lab slide</li>\n</ul>\n</li>\n<li>Metals:\n\t\t\t\t<ul>\n<li>Nails.</li>\n<li>Metallic body implants.</li>\n<li>Scissors.</li>\n<li>Artificial pacemakers.</li>\n</ul>\n</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Cardboard boxes with blue colored markings or blue coloured puncture-proof and tamper-proof containers.</li>\n<li>Disinfection (cleaning with <span class=\"customMeta\" data-dictid=\"24ff542ee616927771865a28edbc12\">detergent</span> and soaking in sodium hypochlorite) or autoclaving or microwaving or hydroclaving and then sent for recycling.</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with deep vein thrombosis was started on a new drug. After 2 days, he presented with the given finding. Which of the following drugs is implicated in causing the above condition?", "options": [{"label": "A", "text": "Warfarin", "correct": true}, {"label": "B", "text": "Heparin", "correct": false}, {"label": "C", "text": "Dabigatran", "correct": false}, {"label": "D", "text": "Rivarox", "correct": false}], "correct_answer": "A. Warfarin", "question_images": ["https://image.prepladder.com/content/nMSloyQLjD5cE8TEzTtU1745383304.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A woman presenting with symptoms of urinary tract infection was prescribed a drug that causes tendon rupture and arthropathy. What is the mechanism of action of the drug?", "options": [{"label": "A", "text": "DNA gyrase inhibition", "correct": true}, {"label": "B", "text": "Ribosomal inhibition", "correct": false}, {"label": "C", "text": "Cell wall synthesis", "correct": false}, {"label": "D", "text": "Inhibition of folic acid synthesis", "correct": false}], "correct_answer": "A. DNA gyrase inhibition", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/4Pcn5TIn0ZDysXi7g7jv1746426124.png", "https://image.prepladder.com/notes/bwryO2t2fvg1UANBjfI61746426178.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The image below shows a pressure sore. Which stage does this belong to?", "options": [{"label": "A", "text": "Stage 1", "correct": false}, {"label": "B", "text": "Stage 2", "correct": false}, {"label": "C", "text": "Stage 3", "correct": false}, {"label": "D", "text": "Stage 4", "correct": true}], "correct_answer": "D. Stage 4", "question_images": ["https://image.prepladder.com/notes/pPtHThkRjC1OiyVITr7G1746428464.png"], "explanation_images": ["https://image.prepladder.com/notes/Aa3JNnJ2csyuyVz09YDV1746428560.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:599px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Pressure <span class=\"customMeta\" data-dictid=\"0d8cd9c1b516927771981287d4850f\">sore</span> stages</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Stage I</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Early <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> ulcer</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Non <span class=\"customMeta\" data-dictid=\"79f30e93e41692777183d60fdfa512\">blanchable erythema</span> of the skin, without breach in the epidermis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Stage II</strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Late <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> ulcer</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Partial thickness, less including <span class=\"customMeta\" data-dictid=\"e4c62a77731692777187b9c7ded25d\">epidermis</span> + dermis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Stage III</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Early deep ulcer</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Full-thickness skin loss involving <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> tissues but not through underlying fascia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Stage IV</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Late deep ulcer</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Full-thickness skin loss involving <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> tissue, muscle, bone, joints or tendon.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Stages of pressure sores\" data-author=\"Bader Aldughayfiq Farzeen Ashfaq Noor Zaman Jhanjhi Mamoona Humayun\" data-hash=\"11722\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/The-Stages-of-Pressure-Ulcer_fig1_370319779\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/Aa3JNnJ2csyuyVz09YDV1746428560.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the fluid shown below on the basis of composition: Sodium (Na+) 131 millimoles per liter Chloride (Cl-) 111 millimoles per liter Lactate 29 millimoles per liter Potassium (K+) 5 millimoles per liter Calcium (Ca2+) 2 millimoles per liter Total osmolarity 279 millimoles per liter", "options": [{"label": "A", "text": "Haemaccel", "correct": false}, {"label": "B", "text": "Ringer lactate", "correct": true}, {"label": "C", "text": "Isolyte", "correct": false}, {"label": "D", "text": "Isolyte M", "correct": false}], "correct_answer": "B. Ringer lactate", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/ZAT3jZ1vE1EHpFR4Erc81746428668.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for an elderly male patient who experienced scrotal pain and discharge, as indicated in the provided image?", "options": [{"label": "A", "text": "Torsion of testis", "correct": false}, {"label": "B", "text": "Acute epididymo-orchitis", "correct": false}, {"label": "C", "text": "Scrotal carcinoma", "correct": false}, {"label": "D", "text": "Fournier’s gangrene", "correct": true}], "correct_answer": "D. Fournier’s gangrene", "question_images": ["https://image.prepladder.com/notes/oundPYTlxCBLZtYMfbQt1746428776.png"], "explanation_images": ["https://image.prepladder.com/notes/Rn1JaiHnqXrRiLC7MuGc1746428888.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:616px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Fournier's Gangrene</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Necrotizing infection</strong> of the soft tissues in the perineum, external genitalia, and <span class=\"customMeta\" data-dictid=\"fb89fe7db116927771957d22da5a71\">perianal</span> region, akin to <span class=\"customMeta\" data-dictid=\"f826a1a46e1692777193319fa1e5ed\">necrotizing</span> fasciitis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Symptoms: <strong>Intense pain in the genitalia,</strong> progressing through<strong> five phases:</strong>\n<ul>\n<li><strong>Prodromal Phase</strong>: Fever and lethargy.</li>\n<li><strong>Early Pain Phase</strong>: Intense pain, possible edema, pruritus.</li>\n<li><strong>Progressive Phase: </strong>Increased pain and erythema.</li>\n<li><strong>Crepitation Phase:</strong> Dusky skin with <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> crepitation.</li>\n<li><strong>Gangrene Phase:</strong> <span class=\"customMeta\" data-dictid=\"741c89cb18169277718889cfaafa53\">Gangrene</span> with <span class=\"customMeta\" data-dictid=\"0c02372a7d1692777196974ab1d772\">purulent</span> discharge.</li>\n</ul>\n</li>\n<li>Pain may decrease as <span class=\"customMeta\" data-dictid=\"741c89cb18169277718889cfaafa53\">gangrene</span> progresses.</li>\n<li>Severity ranges from localised <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> to <span class=\"customMeta\" data-dictid=\"39f67d7dde16927771985d3952058d\">septic</span> shock.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Peripheral <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> disease, diabetes mellitus, malnutrition, alcoholism, <span class=\"customMeta\" data-dictid=\"a3cc9f976916927771895692a1a8a0\">immunocompromised</span> states.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clinical presentation supported by <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> or lab findings.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Initial Treatment:\n\t\t\t\t<ul>\n<li>Fluid resuscitation.</li>\n<li>Broad-spectrum antibiotics.</li>\n<li>Surgical debridement of necrotic tissue.</li>\n</ul>\n</li>\n<li>Additional Measures:\n\t\t\t\t<ul>\n<li>Urinary and fecal <span class=\"customMeta\" data-dictid=\"73224cf5e516927771862db3f8f2f2\">diversion</span> to prevent wound contamination.</li>\n<li>Intensive monitoring for sepsis.</li>\n<li>Wound review and vacuum-assisted dressing.</li>\n<li>Skin <span class=\"customMeta\" data-dictid=\"6ca773c032169277718858b8ad1e9c\">grafting</span> post-infection control.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient was brought to the emergency with a history of consumption of 8 tablets of digoxin. On examination, he was unstable, and his heart rate was 56 bpm. ECG showed a 3rd-degree heart block. What is the next step in the management of this patient?", "options": [{"label": "A", "text": "Antibody against digoxin", "correct": true}, {"label": "B", "text": "Lidocaine", "correct": false}, {"label": "C", "text": "DC cardioversion", "correct": false}, {"label": "D", "text": "Phenytoin", "correct": false}], "correct_answer": "A. Antibody against digoxin", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:2px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Digoxin</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:2px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:2px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of action of digoxin</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:2px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Direct action</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:2px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Indirect action</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:2px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Digoxin ⟶<strong> <span class=\"customMeta\" data-dictid=\"f03ca2d2a716927771901227bc175a\">Inhibition</span> of Na⁺-K⁺ATPase Pump </strong>⟶ <span class=\"customMeta\" data-dictid=\"a621be29da16927771901bc91014d1\">Intracellular</span> Na⁺ Accumulation ⟶ <strong>Intracellular Ca²⁺ Increase</strong> ⟶ Enhanced Myocardial <span class=\"customMeta\" data-dictid=\"3d46029a83169277718580263882c3\">Contractility</span> ⟶ Positive <span class=\"customMeta\" data-dictid=\"d44f29df6116927771902150f69464\">Inotropic</span> Effect ⟶ Increased <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">Cardiac</span> Output ⟶ Treatment of Heart Failure</p>\n</td>\n<td style=\"border-bottom:2px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vagotonic effect</strong> ⟶<strong> Increased parasympathetic/vagal tone </strong>⟶ <span class=\"customMeta\" data-dictid=\"9dc12b322016927771830dff673eeb\">Blocking</span> both S.A and A.V <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> ⟶ <strong>Prolongation of <span class=\"customMeta\" data-dictid=\"3790c638ab16927771970a0a41d3ab\">Refractory</span> Period ⟶ Slowing of <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">Conduction</span> Through AV Node</strong> ⟶ Control of Rate in Arrhythmias</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:2px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:2px solid #000000; vertical-align:top\">\n<p><strong>Signs and symptoms of <span class=\"customMeta\" data-dictid=\"508c1bf22216927771860525d4ef6f\">Digoxin</span> toxicity:</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" rowspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:2px solid #000000; vertical-align:top\">\n<p>Arrhythmias (e.g., atrial fibrillation, <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> tachycardia)</p>\n<p>Hyperkalemia</p>\n<p>Hypokalemia</p>\n<p>Bradycardia</p>\n<p>Neurological symptoms (e.g., confusion, delirium)</p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:2px solid #000000; vertical-align:top\">\n<p><strong>ECG Changes with Digoxin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:2px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>↑ PR Interval → <span class=\"customMeta\" data-dictid=\"93722e23b31692777182e48d478f12\">AV node</span> block</strong></li>\n<li>↑ RR Interval → SA <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> block</li>\n<li>Narrow QRS→ Tells about <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">Ventricular</span> depolarisation - ↑ <span class=\"customMeta\" data-dictid=\"a621be29da16927771901bc91014d1\">intracellular</span> sodium</li>\n<li><strong>Inverted T wave→↓ <span class=\"customMeta\" data-dictid=\"a621be29da16927771901bc91014d1\">intracellular</span> potassium</strong></li>\n<li><strong>Reverse <span class=\"customMeta\" data-dictid=\"63b7807cc41692777200fab227369f\">tick</span> sign/ Salvador Dali sign - Characteristic of <span class=\"customMeta\" data-dictid=\"508c1bf22216927771860525d4ef6f\">digoxin</span> toxicity</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Antidote</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Digoxin-specific <span class=\"customMeta\" data-dictid=\"9d7a12cab116927771811a0079086d\">antibody</span> fragments (<strong>Digibind)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A male patient presents with impotence and absent femoral pulse. The pain in the gluteal region is observed. At which level has the pathology occurred?", "options": [{"label": "A", "text": "Bilateral popliteal arteries", "correct": false}, {"label": "B", "text": "Bilateral internal iliac arteries", "correct": false}, {"label": "C", "text": "Aortoiliac bifurcation", "correct": true}, {"label": "D", "text": "Bilateral femoral arteries", "correct": false}], "correct_answer": "C. Aortoiliac bifurcation", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:681px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Vessels involved and common sites of <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> (in Atherosclerosis)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Vessel</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common Sites of Obstruction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Related Manifestations/Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Aorta</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Infrarenal aorta</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bilateral <span class=\"customMeta\" data-dictid=\"cbc1f41317169277719185421a8e5a\">lower limb</span> ischemia, absent <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> pulses</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Iliac arteries</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> bifurcation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Unilateral <span class=\"customMeta\" data-dictid=\"cbc1f41317169277719185421a8e5a\">lower limb</span> ischemia, absent <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> pulse.</li>\n<li>Pain in the buttock is due to a block in the common <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> or <strong>aortoiliac segment</strong> (30%), often associated with <span class=\"customMeta\" data-dictid=\"960bd9fb3d1692777189abb8d8f4cf\">impotence</span> and is called <strong>Leriche's syndrome.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Femoral artery</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common <span class=\"customMeta\" data-dictid=\"ab8a987431169277720229e09c01d7\">femoral</span> artery</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Calf claudication, absent popliteal and <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> pulses</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Popliteal artery</strong></p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Adductor canal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Calf and foot ischemia, absent <span class=\"customMeta\" data-dictid=\"e272cdded916927771951d2337037d\">pedal</span> pulses</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tibial arteries</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Proximal or mid-calf</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Foot ischemia, absent <span class=\"customMeta\" data-dictid=\"e272cdded916927771951d2337037d\">pedal</span> pulses</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Subclavian artery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Proximal subclavian</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Arm ischemia, absent radial/ulnar pulses.</p>\n<p><strong>Subclavian steal syndrome:</strong></p>\n<p>Obstruction of the first part of the <span class=\"customMeta\" data-dictid=\"9562c879be1692777199afcb12fa54\">subclavian</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> can cause reverse <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> through the vertebral artery, providing <span class=\"customMeta\" data-dictid=\"4de12d1ef31692777184db1d11c6bd\">collateral</span> <span class=\"customMeta\" data-dictid=\"337d16dac5169277718474b97f6e4a\">circulation</span> to the arm but affecting the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> brain and upper limb, with steal being occult, partial, or complete.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Brachial artery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mid-humerus level</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Forearm and hand ischemia, absent radial/ulnar pulses</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with prostate carcinoma, which has now spread to the vertebra. What is the route of spread to the lumbar vertebra?", "options": [{"label": "A", "text": "Batson's plexus", "correct": true}, {"label": "B", "text": "Transcoelomic spread", "correct": false}, {"label": "C", "text": "Inferior vesical vein", "correct": false}, {"label": "D", "text": "Internal iliac vein", "correct": false}], "correct_answer": "A. Batson's plexus", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/4qNk8PaOh0BGsHtVsa1X1746429087.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with a firm, tender, slow-growing mass below the ear as shown in the image below. What could be the diagnosis?", "options": [{"label": "A", "text": "Bezold abscess", "correct": false}, {"label": "B", "text": "Parotid abscess", "correct": true}, {"label": "C", "text": "Upper cervical lymphadenopathy", "correct": false}, {"label": "D", "text": "Osteoma of the mandible", "correct": false}], "correct_answer": "B. Parotid abscess", "question_images": ["https://image.prepladder.com/notes/DglXRPU67kYc51zYbgYN1746258133.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with a tender pulsatile mass, as shown in the image below. What will be done next for this patient?", "options": [{"label": "A", "text": "Ultrasound Doppler", "correct": true}, {"label": "B", "text": "Needle aspiration", "correct": false}, {"label": "C", "text": "CT angiogram with percutaneous management", "correct": false}, {"label": "D", "text": "Intravenous antibiotics for 7 days", "correct": false}], "correct_answer": "A. Ultrasound Doppler", "question_images": ["https://image.prepladder.com/notes/809FCbrRL8hYTlUPaSA61746429365.png"], "explanation_images": ["https://image.prepladder.com/content/9EDME5gw7adKkcVvlRfn1745384380.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:658px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>True Aneurysm</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>False (Pseudoaneurysm)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Involves all three layers of the arterial wall.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Involves only a layer of <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> tissue outside the vessel.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Wall Structure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intima, media, and <span class=\"customMeta\" data-dictid=\"a438935bda1692777180dfaf993677\">adventitia</span> are involved.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Only <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> tissue surrounds the breach.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Morphology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fusiform or saccular.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Typically spherical or ovoid.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Aetiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Atherosclerosis, genetic conditions.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Trauma, surgery, or arterial puncture.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>May be <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> until complications arise.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Often presents with a <span class=\"customMeta\" data-dictid=\"a2af1612021692777196c7044ee75b\">pulsatile</span> mass or pain.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common Locations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Large arteries (e.g., aorta, iliac).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Peripheral arteries (e.g., femoral, popliteal).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Detected by ultrasound, CT, and MRI.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Detected by <span class=\"customMeta\" data-dictid=\"df077f2c3d16927772019f8223e58f\">ultrasound</span> or angiography.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Surgical repair or <span class=\"customMeta\" data-dictid=\"0dc32a9edf1692777187a82b199252\">endovascular</span> techniques.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Repair or <span class=\"customMeta\" data-dictid=\"b2fb1a3a5416927771953ea4fa15e1\">percutaneous</span> methods (e.g., <span class=\"customMeta\" data-dictid=\"ac7e1f394f1692777200c5bb11e4d8\">thrombin</span> injection).</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"430\" src=\"https://image.prepladder.com/content/9EDME5gw7adKkcVvlRfn1745384380.png\" width=\"430\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 32-year-old patient who is a chronic alcoholic presents with oral ulcers and a burning sensation. A picture of the oral cavity is given below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Leukoplakia", "correct": true}, {"label": "B", "text": "Erythroplakia", "correct": false}, {"label": "C", "text": "Submucosal fibrosis", "correct": false}, {"label": "D", "text": "Malakoplakia", "correct": false}], "correct_answer": "A. Leukoplakia", "question_images": ["https://image.prepladder.com/content/WCl3ou1r2aCb3D7bHaNz1745384426.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:611px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Leukoplakia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>White patch on oral mucosa, defined clinically, excluding conditions like <span class=\"customMeta\" data-dictid=\"d176adf87f1692777191722064a021\">lichen</span> planus, candidiasis, etc.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Smoking, tobacco chewing</strong></li>\n<li>Alcohol abuse (especially with smoking)</li>\n<li>Chronic trauma (ill-fitting dentures, cheek bites)</li>\n<li>Associated with <span class=\"customMeta\" data-dictid=\"b49bba8e8a16927771997b281fd66a\">submucous</span> fibrosis, hyperplastic candidiasis, Plummer-Vinson syndrome</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common sites</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Buccal <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> (most common in India)</li>\n<li>Oral commissures, floor of mouth, tongue, gingivobuccal sulcus, lip mucosa</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Age &amp; Gender</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Men in their 40s are 2-3 times more affected than females.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Homogenous</strong>: Smooth or wrinkled white patch, lower <span class=\"customMeta\" data-dictid=\"0c7efd2b8716927771914c8cb19e54\">malignancy</span> risk</li>\n<li><strong>Nodular (speckled)</strong>: White patches on an erythematous base, higher <span class=\"customMeta\" data-dictid=\"0c7efd2b8716927771914c8cb19e54\">malignancy</span> risk</li>\n<li><strong>Erosive (erythroleukoplakia)</strong>: Interspersed with red patches, fissures, highest <span class=\"customMeta\" data-dictid=\"0c7efd2b8716927771914c8cb19e54\">malignancy</span> risk</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Malignant potential</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>1-17.5% risk, average 5% <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> transformation</li>\n<li>Higher risk in <span class=\"customMeta\" data-dictid=\"fd29b16a0e1692777186324bd9a553\">dysplastic</span> lesions and certain locations</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Remove <span class=\"customMeta\" data-dictid=\"f616aee08b169277718361438e1a91\">causative</span> factors</strong>: Spontaneous <span class=\"customMeta\" data-dictid=\"f30740eaeb16927771978fc4c375eb\">regression</span> in some cases.</li>\n<li><strong>Biopsy</strong>: For lesions with high <span class=\"customMeta\" data-dictid=\"f8aaf091221692777191f73e810e94\">malignant</span> potential.</li>\n<li><strong>Surgical <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> or laser/cryotherapy</strong>: For suspicious or small lesions</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with acute exacerbation of asthma; he gives a history of sinusitis and headaches for which he had self-medicated. Examination reveals nasal polyposis; which of the following drugs is likely implicated in this episode of asthma in this patient?", "options": [{"label": "A", "text": "Cotrimoxazole", "correct": false}, {"label": "B", "text": "Co-amoxiclav", "correct": false}, {"label": "C", "text": "Aspirin", "correct": true}, {"label": "D", "text": "Chloramphenicol", "correct": false}], "correct_answer": "C. Aspirin", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Please determine the extent of burn injuries in a preschool-aged child portrayed in the attached image.", "options": [{"label": "A", "text": "15-20%", "correct": false}, {"label": "B", "text": "25-30%", "correct": true}, {"label": "C", "text": "35-40%", "correct": false}, {"label": "D", "text": "10-15%", "correct": false}], "correct_answer": "B. 25-30%", "question_images": ["https://image.prepladder.com/notes/xz8aRZ1iZZUY7dw84Ytx1746429817.png"], "explanation_images": ["https://image.prepladder.com/content/Wg7gkMd5dfX1wzODR36H1745384578.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:552px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Adults</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Children</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Infants</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Head &amp; neck</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>9%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>18%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Front of chest &amp; <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>9 x 2 = 18%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>18%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>10 x 2 = 20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Back of chest &amp; <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>9 x 2 = 18%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>18%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>10 x 2 = 20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lower limb</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>18 x 2 = 36%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>13.5 x 2 = 27%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>10 x 2 = 20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Upper limb</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>9 x 2 = 18%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>18%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>10 x 2 = 20%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Perineum</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Jmarchn\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Wallace_rule_of_nines-en.svg\" data-tags=\"\" height=\"448\" src=\"https://image.prepladder.com/content/Wg7gkMd5dfX1wzODR36H1745384578.png\" width=\"396\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following drugs can cause the shift of potassium back into the cells?", "options": [{"label": "A", "text": "Epinephrine", "correct": true}, {"label": "B", "text": "Acetazolamide", "correct": false}, {"label": "C", "text": "Atropine", "correct": false}, {"label": "D", "text": "Lactic acid", "correct": false}], "correct_answer": "A. Epinephrine", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with acute-onset, severe abdominal pain. He is hemodynamically stable. A chest X-ray is shown below. What is the next step in management?", "options": [{"label": "A", "text": "Gastric lavage", "correct": false}, {"label": "B", "text": "Chest tube insertion", "correct": false}, {"label": "C", "text": "Tracheostomy", "correct": false}, {"label": "D", "text": "Resuscitation and laparotomy", "correct": true}], "correct_answer": "D. Resuscitation and laparotomy", "question_images": ["https://image.prepladder.com/content/EmhdXo6Xo7NHYlWJL85F1745384623.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following structures are in close proximity to the affected structure in a 70-year-old male patient presenting with decreased hearing in higher frequencies, where the basilar membrane has been affected?", "options": [{"label": "A", "text": "Modiolus", "correct": false}, {"label": "B", "text": "Stria vascularis", "correct": false}, {"label": "C", "text": "Oval window", "correct": true}, {"label": "D", "text": "Helicotrema", "correct": false}], "correct_answer": "C. Oval window", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 6-year-old boy came with a history of recurrent urinary tract infections. Imaging was done and is shown below. What is the diagnosis?", "options": [{"label": "A", "text": "Vesicoureteric reflux", "correct": true}, {"label": "B", "text": "Urinary bladder diverticulum", "correct": false}, {"label": "C", "text": "Urinary bladder hernia", "correct": false}, {"label": "D", "text": "Vesicocolic fistula", "correct": false}], "correct_answer": "A. Vesicoureteric reflux", "question_images": ["https://image.prepladder.com/notes/XZjaXT8XNbNOwhFCzV8Q1746430252.png"], "explanation_images": ["https://image.prepladder.com/content/oTRagpRsfKIH7ZKHkSjH1745384765.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Vesicoureteric reflux</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Congenital: </strong>Commonly associated with <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> urethral valve</li>\n<li><strong>Acquired: </strong>Trauma due to surgery or intervention</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Recurrent UTI and Pyelonephritis</li>\n<li>Palpable mass in the loin</li>\n<li>Renal failure in <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> cases</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Renal scarring,</strong> if not managed in <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> patients</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Micturating <span class=\"customMeta\" data-dictid=\"7d3833cfbf1692777185c44c246cf4\">cystourethrogram</span> (IOC)</strong></li>\n<li>Intravenous urography</li>\n<li>Urine <span class=\"customMeta\" data-dictid=\"51df8cdfc91692777192aa76f4de51\">microscopy</span> and C/S</li>\n<li>Blood <span class=\"customMeta\" data-dictid=\"38d4be106e169277720105b006c26b\">urea</span> and <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> creatinine</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Grade I to III-</strong> Antibiotic Prophylaxis as it resolves spontaneously in most patients.</p>\n<p><strong>Grade IV to V- </strong>Antibiotics + Surgery</p>\n<p>Only <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> patients require <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> <span class=\"customMeta\" data-dictid=\"92a52a7756169277718538d58fe1a9\">correction</span> via ureteric reimplantation.</p>\n<p><strong>Surgery:</strong></p>\n<ul>\n<li>Ureterovesicoplasty</li>\n<li>Ureteric <span class=\"customMeta\" data-dictid=\"c6c1d34cf81692777197049241e98d\">reimplantation</span> (Lich-Gregoir technique)</li>\n<li>STING Operation (Endoscopic)</li>\n</ul>\n<p>Severe cases may require <span class=\"customMeta\" data-dictid=\"26983fde4e16927771933da7b06ff9\">nephrectomy</span> and <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> transplantation.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with a pituitary tumor that overproduced growth hormone underwent surgical removal of the tumor. The resection was found to be incomplete. What is the first-line treatment for this patient?", "options": [{"label": "A", "text": "Leuprolide", "correct": false}, {"label": "B", "text": "Goserelin", "correct": false}, {"label": "C", "text": "Nafarelin", "correct": false}, {"label": "D", "text": "Octreotide", "correct": true}], "correct_answer": "D. Octreotide", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A male patient presented with midline neck swelling. He later developed cervical node enlargement. The histopathology of the lesion is shown below. Which of the following statements is false about this condition?", "options": [{"label": "A", "text": "Excellent prognosis is associated with this condition", "correct": false}, {"label": "B", "text": "It spreads quickly via lymphatics", "correct": false}, {"label": "C", "text": "Nuclear characteristics are used for the identification", "correct": false}, {"label": "D", "text": "Fine needle aspiration cytology (FNAC) is not diagnostic", "correct": true}], "correct_answer": "D. Fine needle aspiration cytology (FNAC) is not diagnostic", "question_images": ["https://image.prepladder.com/content/0znDjCwESDKWt0f549H41745384822.png"], "explanation_images": ["https://image.prepladder.com/content/uGNp5mULTjEtt0WBArFo1745384860.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:632px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Papillary cell carcinoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Follicular cells</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Radiation</li>\n<li>Thyroglossal cyst</li>\n<li>Hashimoto’s thyroiditis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Genetics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>BRAF, RET-PTC</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Seen in the 3rd to 4th decade.</li>\n<li>Midline <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> in the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> part of the neck</li>\n<li>Occasionally, <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"c98928d9d516927771805d7cdd0d06\">aberrant</span> <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> is seen.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Metastasis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lymphatic <strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histopathology</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Papillary projections</li>\n<li>Optically clear <span class=\"customMeta\" data-dictid=\"e6b47028191692777193eb698e43b6\">nuclei</span> <strong>(Orphan Annie eye nuclei)</strong></li>\n<li>Pseudo-inclusion bodies</li>\n<li><strong>Psammoma bodies</strong> (Dystrophic calcification)</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Nandi Viljoen, Marc Hedricks, Eugenio Panierii, alessandro aldera\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Histopathology-shows-malignant-glands-and-papillary-structures-with-psammoma-bodies-and_fig2_342157629\" data-tags=\"\" height=\"251\" src=\"https://image.prepladder.com/content/uGNp5mULTjEtt0WBArFo1745384860.png\" width=\"410\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p>These characteristic <span class=\"customMeta\" data-dictid=\"1e9c8202241692777189dbac6cc062\">histological</span> features help for identification.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Excellent <strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which medication, acting as a growth hormone receptor antagonist, is typically prescribed to address a condition marked by chin protrusion, excessive sweating, impaired glucose tolerance, and the enlargement of lands and feet in a middle-aged male patient?", "options": [{"label": "A", "text": "Octreotide", "correct": false}, {"label": "B", "text": "Pegvisomant", "correct": true}, {"label": "C", "text": "Cabergoline", "correct": false}, {"label": "D", "text": "Olcegepant", "correct": false}], "correct_answer": "B. Pegvisomant", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/GtBiKdXiCOTVV9W537oP1746426292.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Drugs used to treat Acromegaly</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>MOA</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Somatostatin analogs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Octreotide; Lanreotide </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inhibits growth hormone <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> by binding to <span class=\"customMeta\" data-dictid=\"375b0300101692777198a7a620f697\">somatostatin</span> receptors.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dopamine agonists</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Bromocriptine;Cabergoline</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reduces growth hormone <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> by binding to <span class=\"customMeta\" data-dictid=\"9194a239ed1692777186bfe41c0e87\">dopamine</span> receptors.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Growth hormone <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antagonists:</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pegvisomant</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blocks the action of <span class=\"customMeta\" data-dictid=\"7a1ae24f701692777187a7f60bbd9f\">excess</span> growth hormone at the <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> level.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A tuberculosis patient on anti-tubercular treatment presents with a tingling sensation and paresthesia in the lower limbs. He is not a diabetic and occasionally consumes alcohol. Which of the following vitamins must be supplemented for this patient?", "options": [{"label": "A", "text": "Vitamin B6", "correct": true}, {"label": "B", "text": "Vitamin B12", "correct": false}, {"label": "C", "text": "Vitamin B2", "correct": false}, {"label": "D", "text": "Vitamin B3", "correct": false}], "correct_answer": "A. Vitamin B6", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An elderly woman received a Botox injection to treat wrinkles. Which of the following is the mechanism of action of botulinum toxin?", "options": [{"label": "A", "text": "Inhibits the release of acetylcholine", "correct": true}, {"label": "B", "text": "Release of noradrenaline at synaptic cleft", "correct": false}, {"label": "C", "text": "Selectively and irreversibly inhibit nicotinic receptors", "correct": false}, {"label": "D", "text": "Stimulates muscarinic and nicotinic receptors", "correct": false}], "correct_answer": "A. Inhibits the release of acetylcholine", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/AlZx9m7F6JNuJUFcgfLf1746426425.png", "https://image.prepladder.com/notes/sUIPG3Wh4EJniQ2hkQ1f1746426567.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young male patient with a history of a motor vehicle accident cannot pass urine. Blood is seen at the meatus. What is the most likely site of urethral injury?", "options": [{"label": "A", "text": "Bulbar urethra", "correct": false}, {"label": "B", "text": "Spongy urethra", "correct": false}, {"label": "C", "text": "Membranous urethra", "correct": true}, {"label": "D", "text": "Penile urethra", "correct": false}], "correct_answer": "C. Membranous urethra", "question_images": ["https://image.prepladder.com/notes/QaM7kVP8o4ioMvc1zaCx1746430535.png"], "explanation_images": ["https://image.prepladder.com/content/UTJOnsmzjBg6d0Z42nPF1745385425.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:633px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Membranous urethra</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Membranous <span class=\"customMeta\" data-dictid=\"a594ff734f16927772016f656d39eb\">urethra</span> (bulbomembranous <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> most common)</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"364\" src=\"https://image.prepladder.com/content/UTJOnsmzjBg6d0Z42nPF1745385425.png\" width=\"309\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Pelvic fractures </strong>(often due to motor vehicle accidents)</li>\n<li>Blunt trauma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Blood at the meatus</strong></li>\n<li><strong>Inability to void</strong></li>\n<li><strong>High-riding <span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\">prostate</span> on rectal exam</strong></li>\n<li><strong>Perineal or <span class=\"customMeta\" data-dictid=\"9011a765f816927771996863c4d12e\">suprapubic</span> pain</strong></li>\n<li>Pelvic <span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\">hematoma</span> associated with <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> fractures</li>\n<li>Possible <span class=\"customMeta\" data-dictid=\"ae1241d478169277718464d90eb75c\">concomitant</span> <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> injury</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Retrograde Urethrography (RGU):</strong> Gold standard for initial assessment</li>\n<li>CT Urethrography: Useful in evaluating complex injuries</li>\n<li>Pelvic CT Scan: Important for associated <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> fractures</li>\n<li>Cystoscopy: Sometimes performed for further evaluation</li>\n<li>If injury at Prostatomembranous <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> - High lying <span class=\"customMeta\" data-dictid=\"19c0231fc41692777196ffce23771d\">prostate</span> → On IVP- <strong>Pie in sky appearance</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A delayed intravenous urogram of a patient is given below. What is the likely diagnosis?", "options": [{"label": "A", "text": "Pelviureteric junction obstruction", "correct": true}, {"label": "B", "text": "Putty kidney", "correct": false}, {"label": "C", "text": "Staghorn calculus", "correct": false}, {"label": "D", "text": "Cystic kidney", "correct": false}], "correct_answer": "A. Pelviureteric junction obstruction", "question_images": ["https://image.prepladder.com/notes/CnzAGWEQTixjIZeOvR841746430631.png"], "explanation_images": ["https://image.prepladder.com/content/LZEEnXuIaLUWfoQmqtoy1745385528.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Pelviureteric <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> obstruction</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Congenital</strong>\n<ul>\n<li><strong>Atresia/stenosis</strong> - Developmental <span class=\"customMeta\" data-dictid=\"50a440f85816927771817d2fe50984\">anomaly</span> that leads to an <span class=\"customMeta\" data-dictid=\"a6795c876e169277719057a1099465\">intrinsic</span> narrowing</li>\n<li><strong>Aberrant left <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> artery</strong> - The presence of an <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> <span class=\"customMeta\" data-dictid=\"72c06d2cc71692777183b1cbaf5bae\">blood vessel</span> compressing the <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> externally</li>\n</ul>\n</li>\n<li><strong>Acquired</strong>\n<ul>\n<li>Scarring from previous infections</li>\n<li><strong>Kidney stones</strong> <strong>(most common)</strong></li>\n<li>Surgery - <span class=\"customMeta\" data-dictid=\"329b77e4b11692777199930404f75c\">stricture</span> formation</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Intermittent Flank Pain - increased <span class=\"customMeta\" data-dictid=\"3d7596c31c1692777203ecf2ce7a17\">fluid intake</span> or diuresis, which increases <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> production and pressure at the <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> site.</li>\n<li>Hematuria - if there are associated <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> stones.</li>\n<li>Recurrent <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">Urinary</span> Tract Infections</li>\n<li>Hydronephrosis - may be <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> in the early stages.</li>\n</ul>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"322\" src=\"https://image.prepladder.com/content/LZEEnXuIaLUWfoQmqtoy1745385528.png\" width=\"299\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Ultrasound</strong></li>\n<li><strong>Diuretic <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> Scan (DTPA Scan) - Investigation of choice</strong></li>\n<li><strong>Whittaker’s Test:</strong> This is an <span class=\"customMeta\" data-dictid=\"1c5272ad3d1692777190e71409d07a\">invasive</span> pressure-flow study used if the DTPA Scan is equivocal, to <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> between true <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> and non-obstructive <span class=\"customMeta\" data-dictid=\"441df40d111692777189b0e31acb06\">hydronephrosis</span> by measuring the pressure <span class=\"customMeta\" data-dictid=\"04136f692516927771888cf07d46a4\">gradient</span> across the PUJ.</li>\n<li><strong>Magnetic Resonance Urography (MRU):</strong> Helps to pinpoint the location and cause of the obstruction.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is a PCSK9 inhibitor?", "options": [{"label": "A", "text": "Evolocumab", "correct": true}, {"label": "B", "text": "Ezetimibe", "correct": false}, {"label": "C", "text": "Bempedoic acid", "correct": false}, {"label": "D", "text": "Clofibrate", "correct": false}], "correct_answer": "A. Evolocumab", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/7vAAg44ZFlXIosmMjbEb1746426728.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old patient complained of pain in one side of the neck. She is afraid of eating food as it worsens the pain. Ultrasound imaging of the salivary glands is done and shown below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Sialolithiasis", "correct": true}, {"label": "B", "text": "Foreign body", "correct": false}, {"label": "C", "text": "Osteoma of the floor of the mouth", "correct": false}, {"label": "D", "text": "Cervical lymphadenopathy", "correct": false}], "correct_answer": "A. Sialolithiasis", "question_images": ["https://image.prepladder.com/notes/7QX5t8ncDbvow21YkNyr1746430845.png"], "explanation_images": ["https://image.prepladder.com/content/K7w4qaNYGDIpX5Dlha6p1745385673.png", "https://image.prepladder.com/content/TQMb883uA16RilAeUq8n1745385682.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:628px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Sialolithiasis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Formation of salivary <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> stones within the <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> ducts</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Commonly Affected Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>30 to 60 years</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Commonly Affected Gland</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Submandibular <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> (85%), </strong>due to its <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> course and the mucinous, <span class=\"customMeta\" data-dictid=\"bf33f8775d169277720289f4026e23\">viscous</span> <span class=\"customMeta\" data-dictid=\"6b0184a84d16927771981289924c2a\">saliva</span> it produces, leads to stagnation and stone formation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Duct abnormalities</li>\n<li>Inflammation</li>\n<li>Increased <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> content in saliva</li>\n<li>Chronic dehydration</li>\n<li>Medications causing decreased salivary flow</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Cyclical <span class=\"customMeta\" data-dictid=\"5e98c7ac6916927771967b424f152e\">postprandial</span> swelling, dryness, asymmetrical <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> enlargement, <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> stone, possible <span class=\"customMeta\" data-dictid=\"5618681fbe16927771804370383aaa\">abscess</span> formation.</p>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"James Heilman, MD\" data-hash=\"\" data-license=\"CC-BY-SA-3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Submandular2.JPG\" data-tags=\"\" height=\"237\" src=\"https://image.prepladder.com/content/K7w4qaNYGDIpX5Dlha6p1745385673.png\" width=\"329\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>Submandibular Swelling</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Diagnostic Methods</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>Conventional Radiographs</strong>: Initial <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> test, but may miss small stones.</li>\n<li><strong>CT Scanning, USG, Magnetic Resonance Sialogram</strong>: More sensitive, especially for small stones.</li>\n<li><strong>Sialography</strong>: Gold standard; involves <span class=\"customMeta\" data-dictid=\"e8a3764ab516927771863f3212fc41\">dye</span> <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">injection</span> for diagnosis and potential <span class=\"customMeta\" data-dictid=\"8dfaeedbf91692777200561b2b1d2f\">therapeutic</span> use.</li>\n<li><strong>Sialendoscopy</strong>: Direct <span class=\"customMeta\" data-dictid=\"33ba8d60fb16927772029d1067e602\">visualization</span> and removal of stones, safer than open surgery.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Jmarchn\" data-hash=\"\" data-license=\"CC-BY-SA-3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:CT_Wharton%27s_duct_sialolithiasis._Case_1._139._indicated.png\" data-tags=\"\" height=\"310\" src=\"https://image.prepladder.com/content/TQMb883uA16RilAeUq8n1745385682.png\" width=\"203\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>CT- Wharton’s <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> Sialolithiasis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Treatment Options</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>Small Distal Stones (&lt;5 mm)</strong>: Endoscopic removal</li>\n<li><strong>Large Distal Stones (&gt;5 mm)</strong>: <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">Duct</span> slitting</li>\n<li><strong>Impacted Stones</strong>: Transoral route</li>\n<li><strong>Intraparenchymal Stones (5–7 mm)</strong>: Endoscopic extraction</li>\n<li><strong>Large Stones (7-10 mm)</strong>: May require transoral slitting or external shock wave <span class=\"customMeta\" data-dictid=\"6713a50e721692777191903bb2160c\">lithotripsy</span> (ESWL)</li>\n<li><strong>Hilar Stones</strong>: Endoscopic removal</li>\n<li><strong>Gland Removal</strong>: Last resort if other treatments fail</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An elderly man presents with rigidity and tremors. On examination, he has blank facial expressions. Which of the following drugs can be used to manage this?", "options": [{"label": "A", "text": "Clozapine", "correct": false}, {"label": "B", "text": "Donepezil", "correct": false}, {"label": "C", "text": "Selegiline", "correct": true}, {"label": "D", "text": "Haloperidol", "correct": false}], "correct_answer": "C. Selegiline", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/vygwiWpDiB5YuIVQvsAO1746426882.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented with a 0.3 cm nodule on the left nasolabial fold. It was excised, and a pathological examination was done. What is the diagnosis?", "options": [{"label": "A", "text": "Basal cell carcinoma", "correct": true}, {"label": "B", "text": "Melanoma", "correct": false}, {"label": "C", "text": "Squamous cell carcinoma", "correct": false}, {"label": "D", "text": "Nevus", "correct": false}], "correct_answer": "A. Basal cell carcinoma", "question_images": ["https://image.prepladder.com/notes/W0fjVyG4updH8FxsSx7V1746430959.png"], "explanation_images": ["https://image.prepladder.com/content/BKY8YkYQEnyrdytApPAo1745385752.png", "https://image.prepladder.com/content/rWrOdo3QNU42edRHYUN01745385755.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Basal cell carcinoma</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Also known as <strong>Rodent Ulcer</strong>.</li>\n<li><strong>Locally invasive</strong>, meaning it destroys surrounding tissues.</li>\n<li>Referred to as <strong>Tear Cancer,</strong> it occurs typically above a line drawn from the ear <span class=\"customMeta\" data-dictid=\"633bbec0f916927771913a073bbea5\">lobule</span> to the corner of the mouth.</li>\n<li>Originates from the <strong>basal layer of the epidermis</strong>.</li>\n<li>The <strong>most common site</strong> is the nose, with the inner <span class=\"customMeta\" data-dictid=\"f92b3ecaa0169277718358accfad7b\">canthus</span> being another frequent location.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Nodular:</strong>\n<ul>\n<li>The most common type.</li>\n<li>Appears as small, slow-growing pearly nodules.</li>\n<li>Characterised by <span class=\"customMeta\" data-dictid=\"25ffcbcc63169277720039fd0b3584\">telangiectatic</span> vessels on the surface.</li>\n<li>Notable for a central depression called umbilication</li>\n<li>It can also be pigmented.</li>\n</ul>\n</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Fania, Luca &amp; Didona, Dario &amp; Morese, Roberto &amp; Campana, Irene &amp; Coco, Valeria &amp; Pietro, Francesca R. &amp; Ricci, Francesca &amp; Pallotta, Sabatino &amp; Candi, Eleonora &amp; Abeni, Damiano &amp; Dellambra, Elena. \" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Nodular-BCC-Pink-sharply-delimited-nodule-with-a-characteristic-shiny-edge-and-small_fig2_346384010\" data-tags=\"\" height=\"274\" src=\"https://image.prepladder.com/content/BKY8YkYQEnyrdytApPAo1745385752.png\" width=\"313\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Kempf, Werner &amp; Mertz, Kirsten &amp; Hofbauer, Günther &amp; Tinguely, Marianne.\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/Nodular-BCC-with-marked-telangiectasias-on-the-right-temple_fig1_256469050\" data-tags=\"\" height=\"269\" src=\"https://image.prepladder.com/content/rWrOdo3QNU42edRHYUN01745385755.png\" width=\"309\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Cystic</strong></li>\n<li><strong>Superficial</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>For non-aggressive tumours on the trunk or extremities, <strong>wide local excision</strong> with a 2 cm margin is usually sufficient.</li>\n<li>For large, aggressive tumours affecting vital or <span class=\"customMeta\" data-dictid=\"ff63f91a5e16927771858327cda029\">cosmetic</span> areas or <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> tumours, <strong>Mohs micrographic surgery</strong> is recommended.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the drug of choice for paracetamol poisoning?", "options": [{"label": "A", "text": "Naloxone", "correct": false}, {"label": "B", "text": "N-acetylcysteine", "correct": true}, {"label": "C", "text": "Bicarbonate", "correct": false}, {"label": "D", "text": "Deferiprone", "correct": false}], "correct_answer": "B. N-acetylcysteine", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/1iwjrnyG0JEWxeEdFTJN1745385811.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Early Stage </strong>(12–36 hours post-ingestion)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Later Stage</strong> (2–4 days post-ingestion)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ol>\n<li>Nausea, <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> &amp; <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain</li>\n<li>Liver tenderness</li>\n<li>↑ <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> transaminases</li>\n<li>No <span class=\"customMeta\" data-dictid=\"4885d5d0021692777189aac6dc80f7\">impairment</span> of consciousness</li>\n</ol>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ol>\n<li>Right <span class=\"customMeta\" data-dictid=\"46ff8ef1ee16927771996bb1697129\">subcostal</span> pain with tender hepatomegaly</li>\n<li>Jaundice</li>\n<li>Coagulopathy</li>\n<li>Renal <span class=\"customMeta\" data-dictid=\"4885d5d0021692777189aac6dc80f7\">impairment</span> or failure</li>\n<li>Hypoglycemia</li>\n<li>Hepatic encephalopathy</li>\n</ol>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following drugs is used in opioid poisoning?", "options": [{"label": "A", "text": "Naloxone", "correct": true}, {"label": "B", "text": "Naltrexone", "correct": false}, {"label": "C", "text": "N-acetylcysteine", "correct": false}, {"label": "D", "text": "Alvimopan", "correct": false}], "correct_answer": "A. Naloxone", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Opioid Overdose/ Poisoning</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clinical, accidental, or suicidal overdose.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Unconsiousness/coma</li>\n<li>Miosis: Pin point pupil</li>\n<li>Respiratory depression</li>\n<li>Dry <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> in the eye/mouth</li>\n<li>Urinary retention</li>\n<li>Constipation</li>\n<li>Flaccid muscles</li>\n<li>Convulsions (in children)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acute overdose/poisoning:</strong> IV Naloxone (Antidote)</p>\n<p> ↓</p>\n<p><strong>Maintenance</strong> (Detoxification phase: To prevent withdrawal):</p>\n<ul>\n<li>Opioids: Buprenorphine, Methadone, Tramadol</li>\n<li>Non-Opioids- Clonidine, Lofexidine</li>\n</ul>\n<p> ↓</p>\n<p><strong>Abstinence</strong> (Prevent relapse):</p>\n<ul>\n<li>DOC: Oral Naltrexone <strong>(Option B)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 56-year-old man presents with fatigue, pallor, abdominal pain, memory loss, and foot drop. He works at a battery recycling plant and has elevated blood lead levels. Which enzyme is affected in the given scenario?", "options": [{"label": "A", "text": "Aminolevulinic acid (ALA) dehydratase", "correct": true}, {"label": "B", "text": "Uroporphyrinogen III Synthase", "correct": false}, {"label": "C", "text": "Uroporphyrinogen I Synthase", "correct": false}, {"label": "D", "text": "Pyruvate dehydrogenase", "correct": false}], "correct_answer": "A. Aminolevulinic acid (ALA) dehydratase", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:736px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Step</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Reaction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Enzyme</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Key Points</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Succinyl <span class=\"customMeta\" data-dictid=\"fdf03479ad16927771847526907130\">CoA</span> + <span class=\"customMeta\" data-dictid=\"6df8c5de5016927771881dc6865f2e\">Glycine</span> → Delta-aminolevulinic acid (ALA)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>ALA Synthase</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mitochondria</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rate-limiting step; requires <span class=\"customMeta\" data-dictid=\"ad5806d5ad1692777196f1158adc4e\">pyridoxal</span> <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> as a cofactor</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2 <span class=\"customMeta\" data-dictid=\"eaa99cd1ab16927771803509d276b7\">ALA</span> → <span class=\"customMeta\" data-dictid=\"5ef55dd557169277719658d60a1191\">Porphobilinogen</span> (PBG)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>ALA Dehydratase</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cytoplasm</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It involves removal of 2 molecules of water; the <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> contains <span class=\"customMeta\" data-dictid=\"39ecb6e07416927772029550b7e74a\">zinc</span> and is inhibited by lead</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4 <span class=\"customMeta\" data-dictid=\"0ee52642941692777194e4ed0b7255\">PBG</span> → Hydroxymethylbilane (HMB)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Uroporphyrinogen I Synthase</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cytoplasm</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4a</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>HMB → <span class=\"customMeta\" data-dictid=\"12cecf9216169277720190cc4f6e97\">Uroporphyrinogen</span> I</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Spontaneous cyclization</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cytoplasm</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4b</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>HMB → <span class=\"customMeta\" data-dictid=\"12cecf9216169277720190cc4f6e97\">Uroporphyrinogen</span> III</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Uroporphyrinogen III Synthase</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cytoplasm</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>5</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Uroporphyrinogen III → <span class=\"customMeta\" data-dictid=\"11b250c1ba169277718522e7cde9a8\">Coproporphyrinogen</span> III</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Uroporphyrinogen Decarboxylase</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cytoplasm</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decarboxylation, removal of 4 molecules of CO2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Coproporphyrinogen III → <span class=\"customMeta\" data-dictid=\"b6cbe38b7316927771961c7c1f5a00\">Protoporphyrinogen</span> III</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Coproporphyrinogen Oxidase</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mitochondria</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>7</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Protoporphyrinogen III → <span class=\"customMeta\" data-dictid=\"510ec2d8ea1692777196c492eae686\">Protoporphyrin</span> III</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Protoporphyrinogen Oxidase</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mitochondria</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>8</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Protoporphyrin III → Heme</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ferrochelatase</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mitochondria</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Insertion of Fe2+</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Heavy metal </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Source of exposure </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical features </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lead</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Non-industrial</p>\n<ul>\n<li>Gasoline from automobile exhaust.</li>\n<li>Contaminated water from lead pipes.</li>\n<li>Lead paints in old homes.</li>\n</ul>\n<p>Industrial</p>\n<ul>\n<li>Battery and <span class=\"customMeta\" data-dictid=\"ff63f91a5e16927771858327cda029\">cosmetic</span> manufacturing</li>\n<li>Printing paint and <span class=\"customMeta\" data-dictid=\"e8a3764ab516927771863f3212fc41\">dye</span> factories</li>\n<li>Glass manufacturing</li>\n<li>Shipbuilding</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Organic lead</p>\n<ul>\n<li>Wrist and/or foot drop.</li>\n<li>Insomnia.</li>\n<li>Headache.</li>\n<li>Mental confusion.</li>\n</ul>\n<p>Inorganic lead</p>\n<ul>\n<li>Anemia.</li>\n<li>Burton’s line - blue lines on gums.</li>\n<li>Colic, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain with diarrhoea/constipation.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with sudden onset right leg pain. An investigation was done, and the obtained image is shown below. What is the investigation?", "options": [{"label": "A", "text": "Digital subtraction angiography", "correct": false}, {"label": "B", "text": "Ultrasound Doppler", "correct": true}, {"label": "C", "text": "MR angiography", "correct": false}, {"label": "D", "text": "Plethysmography", "correct": false}], "correct_answer": "B. Ultrasound Doppler", "question_images": ["https://image.prepladder.com/notes/bLtjxdGHOVxIVp8RhV7s1746431093.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with hair loss, behavioral changes, lateral eyebrow loss, and nail changes. What is the type of poisoning in this case?", "options": [{"label": "A", "text": "Thallium", "correct": true}, {"label": "B", "text": "Arsenic", "correct": false}, {"label": "C", "text": "Mercury", "correct": false}, {"label": "D", "text": "Lead", "correct": false}], "correct_answer": "A. Thallium", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Characteristic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>Alopecia</strong> (1-2 weeks)</li>\n<li>Painful <span class=\"customMeta\" data-dictid=\"04863b50b516927771967b59757561\">polyneuropathy</span> (GBS-like)</li>\n<li>Butterfly-pattern <span class=\"customMeta\" data-dictid=\"a4fdae630a16927771918eaa32d28b\">maculopapular</span> rash</li>\n<li>Loss of <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> 2/3 of eyebrows (Sign <span class=\"customMeta\" data-dictid=\"233d458dd316927771854358419c86\">de</span> Sourcil)</li>\n<li>Mee's lines on nails (Other causes: Arsenic poisoning, <span class=\"customMeta\" data-dictid=\"e379f984b316927771986bb72f5402\">selenium</span> poisoning, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure and chemotherapy)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Antidote</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Prussian Blue (Berlin Blue; <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> <span class=\"customMeta\" data-dictid=\"5a046503cb169277720259dec3f2be\">ferric</span> hexacyanoferrate) which sequesters <span class=\"customMeta\" data-dictid=\"482583c9b71692777200e3f13d54bb\">thallium</span> ions in the intestine, preventing their absorption</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient on TCA develops toxicity with wide QRS complex and right axis deviation. What is used for treatment?", "options": [{"label": "A", "text": "Ammonium chloride", "correct": false}, {"label": "B", "text": "Sodium Bicarbonate", "correct": true}, {"label": "C", "text": "Vitamin C", "correct": false}, {"label": "D", "text": "Atropine", "correct": false}], "correct_answer": "B. Sodium Bicarbonate", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female presented with a headache associated with photophobia and phonophobia. Which of the following drugs can be used for immediate relief?", "options": [{"label": "A", "text": "Topiramate", "correct": false}, {"label": "B", "text": "Flunarizine", "correct": false}, {"label": "C", "text": "Sumatriptan", "correct": true}, {"label": "D", "text": "Propranolol", "correct": false}], "correct_answer": "C. Sumatriptan", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">Acute</span> Migraine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Prevention of Migraine</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Pharmacologic Options:</strong>\n<ul>\n<li><strong>Simple analgesics:</strong> Acetaminophen, aspirin, caffeine.</li>\n<li><strong>NSAIDs: </strong>Naproxen, ibuprofen, tolfenamic acid, diclofenac.</li>\n<li><strong>Triptans (5-HT1B/1D Agonists): </strong>Sumatriptan, rizatriptan, naratriptan, eletriptan, frovatriptan, zolmitriptan.</li>\n<li><strong>Gepants (CGRP <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">Receptor</span> Antagonists):</strong> Rimegepant, ubrogepant.</li>\n<li><strong>Ditans (5-HT1F Agonists):</strong> Lasmiditan.</li>\n<li><strong>Dopamine <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antagonists: </strong>Metoclopramide, prochlorperazine.</li>\n<li>Other options: Combination medications (e.g., acetaminophen, dichloralphenazone, isometheptene), opioids (limited use).</li>\n</ul>\n</li>\n<li><strong>Non-Pharmacologic Management:</strong>\n<ul>\n<li>Identify and avoid triggers.</li>\n<li>Regulated lifestyle: Healthy diet, regular exercise, consistent sleep, stress management (e.g., yoga, meditation).</li>\n<li>Neuromodulation techniques: sTMS, nVNS.</li>\n</ul>\n</li>\n<li><strong>Key Recommendations:</strong>\n<ul>\n<li>Use medications early in an attack.</li>\n<li>If symptoms persist after 60 minutes, consider increasing the initial dose or switching drug classes.</li>\n<li>Individualize treatment based on attack severity and patient response.</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Indications for <span class=\"customMeta\" data-dictid=\"e684325d851692777196af9e64013b\">Preventive</span> Treatment:</strong>\n<ul>\n<li>Consider patients with four or more <span class=\"customMeta\" data-dictid=\"294b46d9061692777192d5d9fe869a\">migraine</span> attacks per month or those unresponsive to <span class=\"customMeta\" data-dictid=\"3acd96d3c91692777180bd966dec76\">abortive</span> treatments.</li>\n</ul>\n</li>\n<li><strong>Pharmacologic Options:</strong>\n<ul>\n<li><strong>Beta Blockers</strong>: <span class=\"customMeta\" data-dictid=\"082f7143eb1692777196df69a3b6cb\">Propranolol</span> <strong>(Option D ruled out)</strong>, metoprolol.</li>\n<li><strong>Antidepressants</strong>: Amitriptyline, nortriptyline, venlafaxine.</li>\n<li><strong>Anticonvulsants</strong>: <span class=\"customMeta\" data-dictid=\"b4bc3f01b316927772005b04f0e449\">Topiramate</span> <strong>(Option A ruled out)</strong>, valproate.</li>\n<li><strong>CGRP Antagonists</strong>: Eptinezumab, erenumab, fremanezumab, galcanezumab.</li>\n<li><strong>Other Medications:</strong> <strong>Flunarizine </strong><strong>(Option B ruled out)</strong>, candesartan, melatonin.</li>\n</ul>\n</li>\n<li><strong>Considerations:</strong>\n<ul>\n<li>Preventive treatments often take<strong> 2–12 weeks</strong> to show effect.</li>\n<li>Side effects vary; some medications require careful monitoring (e.g., weight gain with certain antidepressants).</li>\n<li>Neuromodulation (sTMS) is also FDA-approved for prevention.</li>\n</ul>\n</li>\n<li><strong>Patient Management:</strong>\n<ul>\n<li>Start with low doses and gradually increase.</li>\n<li>Monitor effectiveness and side effects.</li>\n<li>After stabilization, taper off medication after approximately six months to assess ongoing need.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is most likely to be seen due to the rupture of a saccular aneurysm?", "options": [{"label": "A", "text": "Subdural hemorrhage", "correct": false}, {"label": "B", "text": "Subarachnoid hemorrhage", "correct": true}, {"label": "C", "text": "Intracerebral hemorrhage", "correct": false}, {"label": "D", "text": "Hydrocephalus", "correct": false}], "correct_answer": "B. Subarachnoid hemorrhage", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/BtCEIfcZ388i9L3mdMu61745386555.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 10-month-old baby presented with hypsarrhythmia with salaam spells. The drug of choice is:", "options": [{"label": "A", "text": "Valproate", "correct": false}, {"label": "B", "text": "Topiramate", "correct": false}, {"label": "C", "text": "ACTH", "correct": true}, {"label": "D", "text": "Phenobarbital", "correct": false}], "correct_answer": "C. ACTH", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Epileptic spasm</strong></p>\n<p style=\"text-align: center;\"><strong>(also called <span class=\"customMeta\" data-dictid=\"4c815174781692777190e1b4a5d704\">Infantile</span> spasm, <span class=\"customMeta\" data-dictid=\"3fa45fe9451692777202810d42087f\">West syndrome</span> or Hypsarrhythmia)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>They typically occur in infants and are marked by sudden, forceful contractions of the muscles, particularly those of the trunk. The spasms often occur in clusters(5-50), especially upon waking, and are associated with widespread brain abnormalities.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Age Group</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Predominantly occurs in infants, likely due to differences in neuronal function and <span class=\"customMeta\" data-dictid=\"42d710a82c16927771853d21ce8d7f\">connectivity</span> in the <span class=\"customMeta\" data-dictid=\"c219021c491692777189d289f1fc03\">immature</span> CNS.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>EEG Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>It shows hypsarrhythmia, which is <strong>marked by <span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\">diffuse</span> giant slow waves with a <span class=\"customMeta\" data-dictid=\"c961603ce816927771848b1facbfbc\">chaotic</span> background of irregular</strong>, <span class=\"customMeta\" data-dictid=\"225e0697ea1692777193892a2c34c7\">multifocal</span> spikes and sharp waves.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical <span class=\"customMeta\" data-dictid=\"0338b655da16927771984b872baabb\">Spasm</span> EEG</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>During a spasm, the <span class=\"customMeta\" data-dictid=\"149fc70e9a16927771864296cb4e21\">EEG</span> shows significant background suppression, known as the \"electrodecremental response.\"</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>EMG Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reveals a <span class=\"customMeta\" data-dictid=\"0115afa2131692777197b45ae0d136\">rhomboid</span> pattern, distinguishing it from brief <span class=\"customMeta\" data-dictid=\"949f14b6e4169277720075eaacbf1f\">tonic</span> and myoclonic seizures.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Occasional episodes: </strong></p>\n<ul>\n<li><strong>Drug of choice: <span class=\"customMeta\" data-dictid=\"55fd11666f1692777180e80135bda8\">ACTH</span> hormone +/- glucocorticoids</strong></li>\n</ul>\n<p><strong>Associated with <span class=\"customMeta\" data-dictid=\"93b7b2cfd31692777201efc538e5a2\">tuberous</span> <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">sclerosis</span> (lifelong seizures):</strong></p>\n<ul>\n<li><strong>Drug of choice: Vigabatrin</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with an incident of being stabbed in the front part of the abdomen is brought to the emergency. The patient’s vital signs are stable. What will be the next step in managing this case?", "options": [{"label": "A", "text": "Emergency laparotomy", "correct": false}, {"label": "B", "text": "Observation", "correct": false}, {"label": "C", "text": "Intravenous hydration", "correct": false}, {"label": "D", "text": "Further investigation", "correct": true}], "correct_answer": "D. Further investigation", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/uAYnP25O1SsMNLsVegOX1746431265.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female developed hyperprolactinemia and galactorrhea with recurrent episodes of nausea and vomiting. MRI shows pituitary adenoma. Her pregnancy test was negative. She did not give consent for surgery. Which drug should be used in management?", "options": [{"label": "A", "text": "Octreotide", "correct": false}, {"label": "B", "text": "Bromocriptine", "correct": true}, {"label": "C", "text": "Goserelin", "correct": false}, {"label": "D", "text": "Degarelix", "correct": false}], "correct_answer": "B. Bromocriptine", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Prolactinomas</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Explanation </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Prolactinomas are typically microadenomas in pre-menopausal women, as the symptoms of elevated <span class=\"customMeta\" data-dictid=\"760a997a7b1692777196db9355b82a\">prolactin</span> levels often lead to early diagnosis.</li>\n<li>Prolactin levels correlate with the size of the tumour</li>\n<li>Dopamine inhibits the production of prolactin.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Prolactin has <span class=\"customMeta\" data-dictid=\"1b6bd49bf11692777190214aa47f99\">inhibitory</span> effects on <span class=\"customMeta\" data-dictid=\"02315055441692777203a721dd9b19\">FSH</span> &amp; LH.</li>\n<li><strong>Women</strong>: Commonly present with amenorrhea, infertility, and galactorrhea. If the tumour extends beyond the sella, <span class=\"customMeta\" data-dictid=\"d01e44abab16927772010db8725801\">visual field</span> defects &amp; mass effects occur.</li>\n<li><strong>Men</strong>: Typically present with impotence, loss of libido, infertility, or signs of central nervous system (CNS) compression, such as headaches and visual disturbances.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>PRL levels &gt; 200 μg/L most likely indicates prolactinoma</li>\n<li>PRL levels below 100 μg/L may indicate microadenomas</li>\n<li>MRI Head is recommended for all patients with <span class=\"customMeta\" data-dictid=\"9c0ca3c8231692777189437f1ade91\">hyperprolactinemia</span> and it shows as a <span class=\"customMeta\" data-dictid=\"baccb1fb501692777199a254595de0\">suprasellar</span> mass.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dopamine Agonists</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>First-line treatment option</strong></p>\n<ul>\n<li><strong>Cabergoline</strong> - long action and better tolerance <strong> </strong>\n<ul>\n<li>Galactorrhea improves in 90% of patients</li>\n<li>PRL levels are normal in 80% of patients with microadenomas and 70% with macroprolactinomas.</li>\n</ul>\n</li>\n<li><strong>Bromocriptine</strong>\n<ul>\n<li>Shorter action - preferable in women wishing to <strong>conceive</strong></li>\n</ul>\n</li>\n</ul>\n<p>Side effects may include nausea, mental fogging, nightmares, insomnia, <span class=\"customMeta\" data-dictid=\"7d489fad971692777201210257b018\">vertigo</span> and postural hypotension</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Surgery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indication</strong></p>\n<ul>\n<li>Tumor causing <span class=\"customMeta\" data-dictid=\"b775f0c475169277719593c573f6ff\">pituitary</span> apoplexy.</li>\n<li>Cases resistant to medical therapy.</li>\n<li>Invasive macroadenomas affecting vision.</li>\n<li>Pregnant woman with clinical features of tumor.</li>\n<li>Mass effect of tumor persisting &gt; 1 month with medical therapy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radiotherapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reserved for aggressive tumors that do not respond to <span class=\"customMeta\" data-dictid=\"9194a239ed1692777186bfe41c0e87\">dopamine</span> agonists or surgery.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 59-year-old lady presents with a progressive, painless lump in the breast. What is the cause for the following skin change?", "options": [{"label": "A", "text": "Infiltration of subdermal lymphatics", "correct": true}, {"label": "B", "text": "Infiltration of the lactiferous duct", "correct": false}, {"label": "C", "text": "Involvement of Cooper’s ligament", "correct": false}, {"label": "D", "text": "Spread of the tumour to the anterior chest wall", "correct": false}], "correct_answer": "A. Infiltration of subdermal lymphatics", "question_images": ["https://image.prepladder.com/content/bF8Ar9SfqFucKLaGAyel1745386790.png"], "explanation_images": ["https://image.prepladder.com/content/Xl1KyWYKvrr2Yn9fRgZP1745386825.png", "https://image.prepladder.com/notes/nkRHfj7osxjzPNFvzfEu1746431432.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the gun and the corresponding range of the shot that caused the wound", "options": [{"label": "A", "text": "Shot gun, intermediate range", "correct": false}, {"label": "B", "text": "Shot gun, close range", "correct": false}, {"label": "C", "text": "Pistol, near shot", "correct": true}, {"label": "D", "text": "Pistol, close shot", "correct": false}], "correct_answer": "C. Pistol, near shot", "question_images": ["https://image.prepladder.com/notes/71yXAqNNIPOaqIdCzSny1746269361.png"], "explanation_images": ["https://image.prepladder.com/content/QV9QhI2ZBOsVbUK2WZXY1745386758.png", "https://image.prepladder.com/content/W7IOhTNuIFYz4ypqh19g1745386768.png", "https://image.prepladder.com/notes/GYfFpAFPX014JqeJVgqh1746269504.png", "https://image.prepladder.com/notes/EGvptMtZ65X4yHU6oZcJ1746269673.png", "https://image.prepladder.com/notes/jCP5Dv9dUQIBro3MnCoY1746269741.png", "https://image.prepladder.com/notes/BRRL8A3e4eOEd9Iqd8t91746269841.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"5\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Type of shotgun wounds</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type of wound</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Contact</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Close</strong></p>\n<p><strong>(Option B) ruled out</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Short/ Intermediate-range (Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Distant </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Entry wound</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cruciate/Stellate (Skull) or</p>\n<p>Circular</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Circular</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rat-hole like</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Multiple small <span class=\"customMeta\" data-dictid=\"3f8b73c2b51692777195a76ca589cf\">pellet</span> wounds with the mostly dispersed entry wound</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Border of wound</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Contused, <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">Irregular</span> and <strong>muzzled appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clean-cut, <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> or lacerated</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Abraded and scalloped borders</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Irregular</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Blackening</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p>Present around the margins and even inside the wound.</p>\n<p> </p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p> </p>\n<p>Present</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Absent</p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n<p> </p>\n<p>Absent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Burning</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Absent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tattooing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Present</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Images</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Lorenzo Gitto, M.D., Robert Stoppacher, M.D.\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.pathologyoutlines.com/topic/forensicsgunshotwounds.html\" data-tags=\"\" height=\"355\" src=\"https://image.prepladder.com/content/QV9QhI2ZBOsVbUK2WZXY1745386758.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Lorenzo Gitto, M.D., Robert Stoppacher, M.D.\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.pathologyoutlines.com/topic/forensicsgunshotwounds.html\" data-tags=\"\" height=\"231\" src=\"https://image.prepladder.com/content/W7IOhTNuIFYz4ypqh19g1745386768.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Close gunshot wound\" data-author=\"Lorenzo Gitto, M.D., Robert Stoppacher, M.D.\" data-hash=\"11610\" data-license=\"NA\" data-source=\"https://www.pathologyoutlines.com/topic/forensicsgunshotwounds.html\" data-tags=\"May2025\" height=\"257\" src=\"https://image.prepladder.com/notes/GYfFpAFPX014JqeJVgqh1746269504.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Intermediate or Near range gunshot wound\" data-author=\"Joseph Harrington\" data-hash=\"11611\" data-license=\"NA\" data-source=\"https://www.acepnow.com/article/the-clinical-forensic-evaluation-of-gunshot-wounds-in-the-ed/acep_0122-pg20e/\" data-tags=\"May2025\" height=\"213\" src=\"https://image.prepladder.com/notes/EGvptMtZ65X4yHU6oZcJ1746269673.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Distant range shot wound\" data-author=\"DJ Wilks dwilks@nhs.net Y Mirza G Bourke\" data-hash=\"11612\" data-license=\"NA\" data-source=\"https://publishing.rcseng.ac.uk/doi/10.1308/rcsann.2014.96.5.396\" data-tags=\"May2025\" height=\"319\" src=\"https://image.prepladder.com/notes/jCP5Dv9dUQIBro3MnCoY1746269741.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Shooting Range</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Range</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Wound Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Contact shot</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Muzzle in direct contact</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Circular entry wound with <span class=\"customMeta\" data-dictid=\"a36e89561c16927771933be65f4967\">muzzle</span> imprint, severe tissue damage, blackening, and burning of the wound edges. Cherry-red tissue due to <span class=\"customMeta\" data-dictid=\"bb021d26d3169277718336718849a5\">carbon monoxide</span> absorption.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Close-shot</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>&lt; 1 meter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Circular or elliptical entry wound with <strong>blackening, burning, tattooing,, and cherry-red tissue</strong> discolouration due to <span class=\"customMeta\" data-dictid=\"bb021d26d3169277718336718849a5\">carbon monoxide</span> absorption.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Short-range</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>1-2 meters</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Circular 4-5 cm wound (Rat hole) with <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> borders, no blackening, burning, or tattooing.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Intermediate shot</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>2-4 meters</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Large, <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> wound surrounded by multiple satellite wounds.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Distant shot</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>&gt; 4 meters</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The entry wound fades, leaving multiple small <span class=\"customMeta\" data-dictid=\"3f8b73c2b51692777195a76ca589cf\">pellet</span> wounds.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Multidrug-resistant TB refers to mycobacterial resistance to", "options": [{"label": "A", "text": "Isoniazid and Ethionamide", "correct": false}, {"label": "B", "text": "Isoniazid and Rifampicin", "correct": true}, {"label": "C", "text": "Isoniazid, Rifampicin and Ethionamide", "correct": false}, {"label": "D", "text": "Isoniazid, Rifampicin and Ciprofloxacin", "correct": false}], "correct_answer": "B. Isoniazid and Rifampicin", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the type of wound from the image.", "options": [{"label": "A", "text": "Defense wounds", "correct": true}, {"label": "B", "text": "Antemortem wound", "correct": false}, {"label": "C", "text": "Postmortem wound", "correct": false}, {"label": "D", "text": "Hesitation cuts", "correct": false}], "correct_answer": "A. Defense wounds", "question_images": ["https://image.prepladder.com/notes/MNkcSLy5Nb6h3B3xFJW51746269931.png"], "explanation_images": ["https://image.prepladder.com/notes/O1jDdnfP1i1tfocIvK2G1746270107.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:659px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Active defense wounds </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Passive defense wounds </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism of injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The victim tries to grasp the weapon.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The victim raises the arms, legs, or hands.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Site </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Depends on the type of weapon.</li>\n<li>A single-edged weapon causes <strong>a single cut on the palm or the <span class=\"customMeta\" data-dictid=\"247e7aa0181692777182e46b52832d\">bends</span> of fingers or thumb</strong>.</li>\n<li>A double-edged weapon produces<strong> cuts on both the palm and fingers</strong>.</li>\n<li>A typical knife defense wound is seen between the base of the thumb and the index finger.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Extensor or <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">ulnar</span> surfaces</strong> of the forearms, wrists, back of the hands, knuckle.</li>\n<li>Rarely on the <span class=\"customMeta\" data-dictid=\"d3eb7fc1d41692777198c9b9e4364e\">shin</span> and feet.</li>\n<li>Arms and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> aspect of lower limbs and back.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type of Injuries </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Irregular and ragged cuts due to <span class=\"customMeta\" data-dictid=\"15228e561416927771918a5e9e15db\">loosening</span> of skin tension while gripping the knife.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fractures of the <span class=\"customMeta\" data-dictid=\"c8a21e01261692777183ccc5569251\">carpal</span> bones, metacarpals, and digits (mostly <span class=\"customMeta\" data-dictid=\"324b1bfa7816927771834f9e3f6704\">blunt</span> trauma).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Medicolegal importance </strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Defense wounds indicate homicide.</li>\n<li>They are absent if the victim is:\n\t\t\t\t<ul>\n<li>Unconscious</li>\n<li>Taken by surprise</li>\n<li>Attacked from the back</li>\n<li>Under the influence of drugs or alcohol</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Antemortem <span class=\"customMeta\" data-dictid=\"b51ee41cac1692777183b6456a139a\">bruise</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Postmortem bruise</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Swelling is present</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Swelling is absent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Epithelium is damaged</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No epithelial damage</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Extravasation of blood is seen</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No <span class=\"customMeta\" data-dictid=\"f0c6fefae41692777187c76a6f65f6\">extravasation</span> of blood</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Coagulation is present</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Coagulation is absent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tissues are infiltrated with blood</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Not infiltrated with blood</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Color changes are seen</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Uniform color</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Margins merge with the surrounding area</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Margins are sharply demarcated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Appearance is more marked in victims who survive for sometime</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Less marked appearance</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What type of consent is obtained when a patient agrees to a procedure after being informed about its benefits and complications?", "options": [{"label": "A", "text": "Informed consent", "correct": true}, {"label": "B", "text": "Implied consent", "correct": false}, {"label": "C", "text": "Opt-out", "correct": false}, {"label": "D", "text": "Passive consent", "correct": false}], "correct_answer": "A. Informed consent", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented with blunt trauma to the abdomen. On evaluation, liver injury was noted, for which primary repair was done. Coagulation function was monitored intraoperatively using the method shown below. What is the method used?", "options": [{"label": "A", "text": "Thromboelastography", "correct": true}, {"label": "B", "text": "Plethysmography", "correct": false}, {"label": "C", "text": "Sonography", "correct": false}, {"label": "D", "text": "Elastography", "correct": false}], "correct_answer": "A. Thromboelastography", "question_images": ["https://image.prepladder.com/notes/QvNgodFfrH0Lbqe4Bv1U1746431542.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:720px\">\n<tbody>\n<tr>\n<td colspan=\"5\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Stages of Thromboelastogram</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Normal value</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Problem it indicates</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Reaction time</strong><br/>\n\t\t\t </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Time taken for the <span class=\"customMeta\" data-dictid=\"5e0b40993316927771844dbf382689\">clot</span> to start forming</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>7.5-15 mins</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased: Deficiency in <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> factors</p>\n<p>Decreased: Hypercoagulable states</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fresh frozen plasma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>K time- <span class=\"customMeta\" data-dictid=\"5e0b40993316927771844dbf382689\">clot</span> firmness</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Time for the <span class=\"customMeta\" data-dictid=\"5e0b40993316927771844dbf382689\">clot</span> to reach fixed strength</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3-6 mins</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fibrinogen dysfunction</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cryoprecipitate</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Alpha angle</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fibrin linking speed</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>45° and 55°</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fibrinogen dysfunction</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cryoprecipitate</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Maximum amplitude</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The highest vertical <span class=\"customMeta\" data-dictid=\"4c75de951316927771819cdfdbdd6a\">amplitude</span> of TEG</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>50-60 mm</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Platelets (most often)</p>\n<p>Clotting factors</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Platelets</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lysis in 30 mins </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Percentage of <span class=\"customMeta\" data-dictid=\"4c75de951316927771819cdfdbdd6a\">amplitude</span> reduction<br/>\n\t\t\t30 minutes after maximum amplitude</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>0-8%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A high value indicates <span class=\"customMeta\" data-dictid=\"7a1ae24f701692777187a7f60bbd9f\">excess</span> <span class=\"customMeta\" data-dictid=\"803b5ed1c8169277719190b446ac83\">lysis</span> of the clot</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tranexamic acid</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A person after sleeping overnight with the arm under his head now experiences paresis but no numbness in the morning. Which of the following is the best explanation for it?", "options": [{"label": "A", "text": "C fibers are more sensitive to pressure than A fibers", "correct": false}, {"label": "B", "text": "A fibers are more sensitive to hypoxia than B fibers", "correct": false}, {"label": "C", "text": "A fibers are more susceptible to pressure changes than C fibers", "correct": true}, {"label": "D", "text": "A fibers are more susceptible to hypoxia than C fibers", "correct": false}], "correct_answer": "C. A fibers are more susceptible to pressure changes than C fibers", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Fiber Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Myelination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Diameter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Conduction Velocity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Functions</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>A</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Myelinated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Large</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fast</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sharp pain, touch, proprioception</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>B</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Myelinated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Medium</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Moderate</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Autonomic functions</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>C</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Unmyelinated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Small</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Slow</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dull pain, temperature, itch; polymodal</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with diabetes mellitus for the past 5 years presents with vomiting and abdominal pain. She is non-compliant with medication and appears dehydrated. Investigations revealed a blood sugar value of 500 mg/dL and the presence of ketone bodies. What is the next best step in management?", "options": [{"label": "A", "text": "Intravenous fluids with long-acting insulin", "correct": false}, {"label": "B", "text": "Intravenous fluids", "correct": false}, {"label": "C", "text": "Intravenous insulin", "correct": false}, {"label": "D", "text": "Intravenous fluids with regular insulin", "correct": true}], "correct_answer": "D. Intravenous fluids with regular insulin", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Z6foV1CDM5hBuW1tW3781745387537.png", "https://image.prepladder.com/content/apY1J4z8bXHbSl55kxdc1745387569.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:595px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Signs</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Nausea and vomiting</li>\n<li>Abdominal pain</li>\n<li>Thirst, polyuria, and polydipsia</li>\n<li>Weight loss</li>\n<li>Weakness and fatigue</li>\n<li>Shortness of breath</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Dehydration </strong>(dry <span class=\"customMeta\" data-dictid=\"26080f047a169277719334625cadef\">mucous</span> membranes, poor skin turgor)</li>\n<li>Hypotension (postural or supine)</li>\n<li>Tachycardia</li>\n<li>Hypothermia</li>\n<li>Tachypnea</li>\n<li><strong>Kussmaul respiration</strong> (deep, labored breathing)</li>\n<li><strong>Fruity <span class=\"customMeta\" data-dictid=\"ad1552dd561692777194d3a54eede2\">odor</span> of <span class=\"customMeta\" data-dictid=\"232d82732d1692777180f30a65a740\">acetone</span> on the breath</strong></li>\n<li>Abdominal <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> resembling <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> abdomen</li>\n<li>Lethargy, obtundation, possible cerebral edema, or coma</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following mechanisms is seen in the baroreceptor reflex?", "options": [{"label": "A", "text": "Feedforward", "correct": false}, {"label": "B", "text": "Positive feedback", "correct": false}, {"label": "C", "text": "Negative feedback", "correct": true}, {"label": "D", "text": "Both A &amp;amp; B are correct", "correct": false}], "correct_answer": "C. Negative feedback", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/NkFC4g7EzENZJINkATkQ1746270278.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>System</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Stimulus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Response</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Effect</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Body Temperature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Temperature deviation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sweating/shivering, vasodilation/constriction</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Restores normal temperature</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood Glucose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High/low blood glucose</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Insulin/glucagon release</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normalises blood <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> levels</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Thyroid Hormones</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High/low <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> hormones</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>TSH release adjustment</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Maintains hormone balance</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blood Pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High/low blood pressure</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Heart rate and vessel adjustment</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Restores normal blood pressure</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Calcium Homeostasis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High/low blood calcium</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>PTH/calcitonin release</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normalises blood <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> levels</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Menstrual Cycle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hormone level changes</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>FSH/LH regulation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Regulates <span class=\"customMeta\" data-dictid=\"3a03cad6c616927771925038b55989\">menstrual</span> cycle</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Respiratory Rate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>High CO<sub>2</sub> levels</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased breathing rate</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normalizes CO<sub>2</sub> levels</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The cerebrospinal fluid (CSF) specimen of a patient is shown below, along with microscopy. The report shows mononuclear cytosis, elevated proteins, and low sugars. What is the likely etiology?", "options": [{"label": "A", "text": "Tuberculous meningitis", "correct": true}, {"label": "B", "text": "Aseptic meningitis", "correct": false}, {"label": "C", "text": "Bacterial meningitis", "correct": false}, {"label": "D", "text": "Chemical meningitis", "correct": false}], "correct_answer": "A. Tuberculous meningitis", "question_images": ["https://image.prepladder.com/notes/tAyJYqDzY7xsgOGaKt4d1746270940.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:720px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Parameter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Bacterial <span class=\"customMeta\" data-dictid=\"7d8f74eaae16927771928214d10c17\">Meningitis</span> (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Viral <span class=\"customMeta\" data-dictid=\"7d8f74eaae16927771928214d10c17\">Meningitis</span> (Aseptic Meningitis) (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Fungal Meningitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Tuberculous Meningitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Turbid/cloudy</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clear</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clear/slightly cloudy</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cobweb appearance</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Opening Pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal or slightly elevated</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>WBC Count</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>100–10,000/µL (predominantly neutrophils)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>10–500/µL (predominantly lymphocytes)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>20–500/µL (predominantly lymphocytes)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>50–500/µL (predominantly lymphocytes)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Protein</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated (&gt;100 mg/dL)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal or slightly elevated (50–100 mg/dL)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated (50–200 mg/dL)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated (100–500 mg/dL)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Glucose</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreased (&lt;40 mg/dL or &lt;40% of <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> glucose)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal (&gt;40 mg/dL or &gt;50% of <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> glucose)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreased (&lt;40 mg/dL or &lt;50% of <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> glucose)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreased (&lt;40 mg/dL or &lt;50% of <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> glucose)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following types of cell- to-cell signaling is depicted in the image below?", "options": [{"label": "A", "text": "Paracrine", "correct": true}, {"label": "B", "text": "Autocrine", "correct": false}, {"label": "C", "text": "Endocrine", "correct": false}, {"label": "D", "text": "Merocrine", "correct": false}], "correct_answer": "A. Paracrine", "question_images": ["https://image.prepladder.com/notes/qp4R9Hf1adzBRC8FnRGB1746270408.png"], "explanation_images": ["https://image.prepladder.com/notes/hDMsQ1yF3YaSMTM3f0Kw1746270468.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Examples</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Autocrine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Cells release molecules that bind to their own receptors, influencing self-regulation.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tumor cells promoting growth.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Paracrine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Molecules released into <span class=\"customMeta\" data-dictid=\"ba366417791692777187229d34e597\">extracellular</span> fluid affect nearby cells.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Local tissue responses.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Endocrine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hormones travel through the <span class=\"customMeta\" data-dictid=\"a813884d6016927771838d2d1f9d1d\">bloodstream</span> to reach distant targets.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Regulation of <span class=\"customMeta\" data-dictid=\"5b1a045f5f169277719210c0ac7a1e\">metabolism</span> via insulin.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gap Junction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Small molecules and ions pass directly between adjacent cells via gap junctions.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Synchronization in <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> tissue.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Component</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Signaling Molecules</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Include hormones, neurotransmitters, cytokines, and growth factors; classified as <span class=\"customMeta\" data-dictid=\"db283047011692777189a869dbce07\">hydrophilic</span> (e.g., peptides) or <span class=\"customMeta\" data-dictid=\"e3be2eb847169277718953f0dae57d\">hydrophobic</span> (e.g., steroids).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Receptors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Proteins that bind <span class=\"customMeta\" data-dictid=\"f9016f36fd1692777198b0fd5e9c6d\">signaling</span> molecules; key types include:</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>G-Protein-Coupled (GPCRs)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Activate <span class=\"customMeta\" data-dictid=\"a621be29da16927771901bc91014d1\">intracellular</span> G-proteins to elicit responses.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ion Channel Receptors</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Regulate <span class=\"customMeta\" data-dictid=\"4b2f2a6d0a16927771902f60fa9ff7\">ion</span> flow upon <span class=\"customMeta\" data-dictid=\"6e1f8c026516927771919d54418520\">ligand</span> binding.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Enzyme-Linked Receptors</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Activate enzymes or possess <span class=\"customMeta\" data-dictid=\"a6795c876e169277719057a1099465\">intrinsic</span> <span class=\"customMeta\" data-dictid=\"11d4157da4169277718762144a4fe7\">enzymatic</span> activity.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most likely cause of death in a body with a horizontal ligature mark completely encircling the neck and located below the thyroid, with no dribbling of saliva?", "options": [{"label": "A", "text": "Throttling", "correct": false}, {"label": "B", "text": "Ligature strangulation", "correct": true}, {"label": "C", "text": "Gagging", "correct": false}, {"label": "D", "text": "Hanging", "correct": false}], "correct_answer": "B. Ligature strangulation", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Finding</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\"><strong>Face</strong></td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Congested, swollen, and cyanosed.</li>\n<li>Tardieu's spots (petechiae) on the forehead, temples, eyelids, and conjunctiva.</li>\n<li>Prominent eyes with <span class=\"customMeta\" data-dictid=\"8edfbdf9211692777184ea95263168\">congested</span> conjunctiva, dilated pupils, and possible <span class=\"customMeta\" data-dictid=\"335f16a33c16927771992f5c55bc4d\">subconjunctival</span> haemorrhages.</li>\n<li>Cyanosis of lips, fingernails, and earlobes.</li>\n<li>Postmortem <span class=\"customMeta\" data-dictid=\"3b007026bd16927771997ae809b603\">staining</span> above the ligature.</li>\n<li>Swollen, dark-coloured, protruding tongue, possibly bitten.</li>\n<li>Bloodstained frothy fluid and <span class=\"customMeta\" data-dictid=\"ab75ea330616927771938a64f8ebd6\">mucus</span> in mouth and nostrils.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\"><strong>Neck</strong></td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Ligature mark ('furrow'): well-defined groove, typically the same <span class=\"customMeta\" data-dictid=\"1b0d31fe811692777202644090ba60\">width</span> as the ligature, often horizontal.</li>\n<li>More prominent on the front and sides of the neck.</li>\n<li>Red base with <span class=\"customMeta\" data-dictid=\"8edfbdf9211692777184ea95263168\">congested</span> or <span class=\"customMeta\" data-dictid=\"dbd45d28f31692777186226570e867\">ecchymosed</span> margins; <span class=\"customMeta\" data-dictid=\"522f9728161692777189dac58f3dfd\">imprint</span> pattern may be present.</li>\n<li>Can be indistinct if the <span class=\"customMeta\" data-dictid=\"3e0d0648b81692777191eca3015435\">ligature</span> is soft; it may appear as a deep <span class=\"customMeta\" data-dictid=\"21ee3a5f911692777188099a3310c4\">groove</span> with a narrow cord ('cheese cutter method').</li>\n<li>May show an <span class=\"customMeta\" data-dictid=\"dd88c7c9741692777194fe0cc9abaa\">oblique</span> appearance if the victim was dragged post-strangulation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\"><strong>Other Body Parts</strong></td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Deep, prominent <span class=\"customMeta\" data-dictid=\"88bcb684bf169277719687b1e4d84b\">postmortem</span> staining.</li>\n<li>Involuntary <span class=\"customMeta\" data-dictid=\"9dd87431ba1692777186ecfb21d258\">discharge</span> of <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> and faecal matter; less common seminal ejaculation.</li>\n<li>Clenched hands; possible <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">genital</span> turgidity.</li>\n<li>Possible abrasions, <span class=\"customMeta\" data-dictid=\"5089296e801692777202c49d61e9f4\">fingernail</span> marks, and contusions on face, and arms, indicating struggle.</li>\n<li>Horizontal, <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> abrasions on the neck may indicate attempts to remove ligature.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Hanging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Strangulation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Face</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Usually, pale, <span class=\"customMeta\" data-dictid=\"8fad605541169277719552afc9ebac\">petechiae</span> are less common</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Congested, <span class=\"customMeta\" data-dictid=\"a0e7b4cc771692777191d9238fdce1\">livid</span> with petechiae</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Tongue <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> and protrusion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Less marked</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>More marked</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Bleeding from nose, ears, mouth</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Less common</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>More common</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Ligature mark ('furrow')</strong></p>\n<ul>\n<li>Direction</li>\n<li>Continuity</li>\n<li>Level in the neck</li>\n<li>Base</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Oblique</li>\n<li>Noncontinuous</li>\n<li>Above thyroid</li>\n<li>Pale, hard, parchment-like</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Transverse</li>\n<li>Continuous</li>\n<li>Below thyroid</li>\n<li>Soft and reddish</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Abrasions and <span class=\"customMeta\" data-dictid=\"8ae06fb05116927771863f729ea53c\">ecchymoses</span> about the edges of the mark</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p>Not common</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p>Common</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Involuntary <span class=\"customMeta\" data-dictid=\"9dd87431ba1692777186ecfb21d258\">discharge</span> of <span class=\"customMeta\" data-dictid=\"7f789a76331692777202a90df3adb4\">feces</span> and urine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Less common</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>More common</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Involuntary <span class=\"customMeta\" data-dictid=\"9dd87431ba1692777186ecfb21d258\">discharge</span> of seminal fluid</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>More common</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Less common</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Bruising of neck muscles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Less common</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>More common</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Subcutaneous tissue under the mark</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>White, hard, glistening</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Ecchymosed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Hyoid bone fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>May occur</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Uncommon</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Thyroid fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Unlikely</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>More common</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Larynx and <span class=\"customMeta\" data-dictid=\"9ebd78bd471692777200ede69e8ed1\">trachea</span> fracture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Unlikely</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>May be found</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Emphysematous <span class=\"customMeta\" data-dictid=\"fc2efe08081692777183a5a07d6101\">bullae</span> on lungs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p>Sometimes present</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p>Very common</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Carotid arteries</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Damage may be seen in the intima</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Rare</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Design</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>History of previous unsuccessful attempts of suicide may be available</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>No such history is available</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Signs of struggle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Absent</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Always present, unless taken unaware</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is true regarding the given cystometrogram?", "options": [{"label": "A", "text": "Segment la is due to residual urine", "correct": false}, {"label": "B", "text": "Segment Ib is due to Laplace law", "correct": true}, {"label": "C", "text": "Micturition fails to happen in segment II", "correct": false}, {"label": "D", "text": "Micturition occurs in segment Ib", "correct": false}], "correct_answer": "B. Segment Ib is due to Laplace law", "question_images": ["https://image.prepladder.com/notes/IwHW7OPSfitG1Z8xhjH21746270575.png"], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p style=\"text-align: center;\"><strong>Phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Filling Phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Gradual <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> of bladder, pressure rises, <span class=\"customMeta\" data-dictid=\"80d318a6701692777186805934d86a\">detrusor</span> contracts</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Emptying Phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Rhythmic contractions, high-frequency pressure oscillations</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Rebound Phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Pves increase post-voiding, indicates <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">residual</span> pressure change</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A surgeon returns home from a party after many pegs of alcohol and was called to perform an emergency operation. During the operation, the assisting staff noticed the surgeon’s hand shaking and instruments falling. He eventually nicks an artery and the patient collapses. Under which of the following terms will this incident be tried?", "options": [{"label": "A", "text": "Criminal negligence", "correct": true}, {"label": "B", "text": "Civil negligence not amounting to criminal negligence", "correct": false}, {"label": "C", "text": "Therapeutic misadventure", "correct": false}, {"label": "D", "text": "Dichotomy", "correct": false}], "correct_answer": "A. Criminal negligence", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>BNS Section</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Offense</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>BNS Section 269</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>This section pertains to <strong>negligent acts</strong> that are likely to spread infection of a disease dangerous to life.</li>\n<li>The punishment can be imprisonment for up to six months or a fine or both.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>BNS Section 272</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>This section deals with <strong>malignant acts</strong> likely to spread infection of disease dangerous to life.</li>\n<li>The punishment can be imprisonment for up to two years or fine.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>BNS Section 106</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>This section deals with causing death by negligence.</li>\n<li>It applies when death is caused by a <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> or negligent act that does not amount to culpable homicide.</li>\n<li>The punishment for such an offense is imprisonment for up to two years, or a fine, or both.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>BNS Section 109</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>This section pertains to attempt to murder.</li>\n<li>The punishment can extend to imprisonment for life, or imprisonment of up to 10 years and a fine.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Civil Negligence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Criminal Negligence</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Offense</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No specific and clear violation of law</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Must have specifically violated a particular criminal law</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Negligence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Simple absence of care and skill</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gross negligence, inattention, or lack of competence</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Conduct of physician</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Compared to a generally accepted simple standard of conduct</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Not compared to a single test</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Consent for act</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Good defense, cannot recover damages</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Not a defense, can be prosecuted</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Trial by</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Civil court</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Criminal court</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Evidence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Strong evidence is sufficient</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Guilt must be proved beyond reasonable doubt</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Punishment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Liable to pay damages</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Imprisonment, fine, or both</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Contributory negligence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Defense for doctor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Not a defense</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Double jeopardy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cannot be tried twice for the same offense</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Can be tried twice for the same crime</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Damage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Repairable damage or harm to patient</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Irreparable damage to the patient</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Dispute</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Between two parties in their individual capacities</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Between the State and the offending doctor</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complainant</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sufferer party is the complainant</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Public prosecutor on behalf of the State is the complainant</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What changes do not occur in stage A as compared to stage B when the hypothalamic thermostat in a patient is reset from point A to point C, as depicted below?", "options": [{"label": "A", "text": "Shivering", "correct": false}, {"label": "B", "text": "Vasoconstriction", "correct": false}, {"label": "C", "text": "Sweating", "correct": true}, {"label": "D", "text": "Epinephrine secretion", "correct": false}], "correct_answer": "C. Sweating", "question_images": ["https://image.prepladder.com/notes/tene3VlZzRPpslILJSEO1746270657.png"], "explanation_images": ["https://image.prepladder.com/notes/UBxNJQxubDkAYIHoKppr1746270723.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Set Point vs Actual Temp</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Body’s Perception</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Physiological Responses</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage A</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Set point &gt; actual temp</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Feels cold</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Shivering, vasoconstriction, ↑Epi</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage B</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Set point drops to normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Feels hot</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sweating</strong>, vasodilation</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a patient who experienced a stroke 2 days ago, the current symptoms include uncontrollable, forceful, and jerking motions of the limbs on one side. Where is the probable location of the lesion in this individual?", "options": [{"label": "A", "text": "Subthalamic nuclei", "correct": true}, {"label": "B", "text": "Substantia nigra", "correct": false}, {"label": "C", "text": "Putamen", "correct": false}, {"label": "D", "text": "Caudate nucleus", "correct": false}], "correct_answer": "A. Subthalamic nuclei", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient diagnosed to be retro-positive was started on highly active antiretroviral therapy (HAART). Which of the following can be used to monitor treatment efficacy?", "options": [{"label": "A", "text": "CD4+ T cell count", "correct": false}, {"label": "B", "text": "Viral load", "correct": true}, {"label": "C", "text": "p24 antigen", "correct": false}, {"label": "D", "text": "Viral serotype", "correct": false}], "correct_answer": "B. Viral load", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which organization is responsible for vaccines, child health and nutrition, safe water and sanitation, quality education and skill-building?", "options": [{"label": "A", "text": "CARE", "correct": false}, {"label": "B", "text": "UNDP", "correct": false}, {"label": "C", "text": "UNICEF", "correct": true}, {"label": "D", "text": "WHO", "correct": false}], "correct_answer": "C. UNICEF", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/inKRy2EOMV9w2MGyCG2G1745389489.png"], "explanation": "<p>Correct Option C - UNICEF\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Many children from a particular community coming to a hospital were detected to have acute lymphoblastic leukemia (ALL). It was assumed that it is due to the presence of cytotoxic waste in the water of that community. If a case-control study has to be done to find whether the chemical and ALL are associated, what will be taken as the control?", "options": [{"label": "A", "text": "Children from the area exposed, but unaffected with the disease", "correct": false}, {"label": "B", "text": "Children from the area not exposed and affected with the disease", "correct": false}, {"label": "C", "text": "Children coming to your OPD, who do not have the disease", "correct": true}, {"label": "D", "text": "All children with ALL irrespective of exposure status", "correct": false}], "correct_answer": "C. Children coming to your OPD, who do not have the disease", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - Children coming to your OPD, who do not have th\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Open vial policy is accepted for?", "options": [{"label": "A", "text": "BCG", "correct": false}, {"label": "B", "text": "Measles", "correct": false}, {"label": "C", "text": "JE", "correct": false}, {"label": "D", "text": "IPV", "correct": true}], "correct_answer": "D. IPV", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - &lt;span class=\"customMeta\" data-dictid=\"5bf3fa806f169277719089b8172998\"&gt;IPV&lt;/span&gt; (Inactivated &lt;span class=\"customMeta\" data-dictid=\"7b1b23cdec1692777196fb5ec9f3f5\"&gt;Polio&lt;/span&gt; Vaccine)\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female patient presents to you with a unilateral headache. It is associated with nausea, photophobia, and phonophobia. What is the drug of choice for acute management?", "options": [{"label": "A", "text": "Flunarizine", "correct": false}, {"label": "B", "text": "Sumatriptan", "correct": true}, {"label": "C", "text": "Propranolol", "correct": false}, {"label": "D", "text": "Topiramate", "correct": false}], "correct_answer": "B. Sumatriptan", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The patient exhibits a numbed region on the face, depicted in the image provided. Which nerve is most frequently affected in this particular condition?", "options": [{"label": "A", "text": "Abducens nuclei", "correct": false}, {"label": "B", "text": "Facial nerve", "correct": true}, {"label": "C", "text": "Optic nerve", "correct": false}, {"label": "D", "text": "Trigeminal nerve", "correct": false}], "correct_answer": "B. Facial nerve", "question_images": ["https://image.prepladder.com/notes/3IkKB1QHp1l9Tr9cdFte1746256293.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Facial Nerve (CN VII) Involvement</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Function</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Motor to <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> muscles, taste from <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> 2/3 of tongue</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Affected Branches</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Zygomatic &amp; <span class=\"customMeta\" data-dictid=\"d72626dd5c1692777183f1c92b2deb\">Buccal</span> branches</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Symptoms in Leprosy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Facial weakness, inability to close eye (lagophthalmos), drooping face</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Corneal ulcers, <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> deformity</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What could be the likely diagnosis for a 16-year-old girl who experiences strong food cravings and engages in excessive eating followed by self-induced vomiting?", "options": [{"label": "A", "text": "Anorexia nervosa", "correct": false}, {"label": "B", "text": "Bulimia nervosa", "correct": true}, {"label": "C", "text": "Atypical depression", "correct": false}, {"label": "D", "text": "Binge eating disorder", "correct": false}], "correct_answer": "B. Bulimia nervosa", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/cnKgJofTByu0L8VGUc851745391055.png"], "explanation": "<p>Correct Answer B - &lt;span class=\"customMeta\" data-dictid=\"d4ce40066d169277718367f4c3b21c\"&gt;Bulimia&lt;/span&gt; nervosa</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align: center;\"><strong>Features of <span class=\"customMeta\" data-dictid=\"d4ce40066d169277718367f4c3b21c\">Bulimia</span> nervosa</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Binge Eating Episodes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Recurring episodes of <span class=\"customMeta\" data-dictid=\"45c64c16b516927771832de6bd0523\">binge</span> eating, occurring at least weekly for the last 3 months.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Compensatory Behaviors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Purging behaviours (self-induced vomiting, <span class=\"customMeta\" data-dictid=\"452c3c115d169277719186b3353c18\">laxative</span> abuse, diuretics), excessive exercise, fasting.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>BMI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Often normal or slightly <span class=\"customMeta\" data-dictid=\"e01b899fb61692777194fb4270ce6f\">overweight</span> (compared to <span class=\"customMeta\" data-dictid=\"8deb4a7e2b1692777181c91be40ed9\">anorexia</span> nervosa).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Gender <span class=\"customMeta\" data-dictid=\"f86aae0bd61692777196f91458c9dd\">prevalence</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>More common in females than males</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Physical Signs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Parotid <span class=\"customMeta\" data-dictid=\"4744bb90c21692777188c8957f9faa\">gland</span> <span class=\"customMeta\" data-dictid=\"3baac9012a1692777189cb4dc70c04\">hypertrophy</span> (may see increased <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> amylase)</li>\n<li>Enamel <span class=\"customMeta\" data-dictid=\"8f88b9c691169277718754ca072062\">erosion</span> (from vomiting)</li>\n<li>Mallory-Weiss syndrome (esophageal tears)</li>\n<li>These signs appear due to repeated purging.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Electrolyte Disturbances</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Commonly, <span class=\"customMeta\" data-dictid=\"3f0fd5e3bf1692777189b24e452bca\">hypokalemia</span> and hypochloremia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Metabolic Changes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Metabolic <span class=\"customMeta\" data-dictid=\"0dae4cbf251692777181bd4fb21a24\">alkalosis</span> due to vomiting.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Physical Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Dorsal hand calluses from <span class=\"customMeta\" data-dictid=\"f3063c1d8b169277719018bf869980\">induced</span> <span class=\"customMeta\" data-dictid=\"998fb41ebc1692777202e46891c4a7\">vomiting</span> <strong>(Russell sign)</strong>.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Kyukyusha\" data-hash=\"\" data-license=\"OPEN ACCESS\" data-source=\"https://en.wikipedia.org/wiki/Russell%27s_sign#/media/File:Russell's_Sign.png\" data-tags=\"\" height=\"384\" src=\"https://image.prepladder.com/content/cnKgJofTByu0L8VGUc851745391055.png\" width=\"435\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment for Bulimia Nervosa</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cognitive Behavioral Therapy (CBT)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>This is the first-line treatment, <span class=\"customMeta\" data-dictid=\"fefa53d9f216927772037e31a651d7\">focusing</span> on modifying distorted thoughts and behaviours related to eating and body image.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Nutritional Rehabilitation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is aimed at restoring healthy eating patterns and addressing nutritional deficiencies</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Antidepressants</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Fluoxetine</li>\n<li>Topiramate</li>\n<li>Bupropion</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A hypertensive patient who is non-compliant with medication presents with sudden-onset breathlessness. A chest X-ray reveals findings consistent with pulmonary edema. How will you manage this patient?", "options": [{"label": "A", "text": "Intravenous salbutamol", "correct": false}, {"label": "B", "text": "Intravenous nitroglycerin", "correct": true}, {"label": "C", "text": "Nebulization with salbutamol", "correct": false}, {"label": "D", "text": "Oxygen and antibiotics", "correct": false}], "correct_answer": "B. Intravenous nitroglycerin", "question_images": ["https://image.prepladder.com/content/3hXHSGJ11e9oy3oaKkpF1745391160.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents to you with multiple anogenital warts. The biopsy of these lesions showed squamous atypia. Which of the following human papillomavirus types are considered high-risk?", "options": [{"label": "A", "text": "HPV 2", "correct": false}, {"label": "B", "text": "HPV 18", "correct": true}, {"label": "C", "text": "HPV 6", "correct": false}, {"label": "D", "text": "HPV 11", "correct": false}], "correct_answer": "B. HPV 18", "question_images": ["https://image.prepladder.com/notes/BH3LaGsz7E4nL9ZF532h1746256395.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:534px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>HPV Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Risk Level</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Associated Conditions</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>HPV 6, 11</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low-risk</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anogenital warts, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> papillomatosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>HPV 16, 18</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High-risk</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cervical, anal, oropharyngeal, and penile cancers</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>HPV 31, 33, 45</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>High-risk</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cervical and vulvar cancers</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient on antidepressants presents with hypotension. An ECG reveals wide QRS complexes and right axis deviation. How will you manage this patient?", "options": [{"label": "A", "text": "Antiarrhythmics", "correct": false}, {"label": "B", "text": "Intravenous sodium bicarbonate", "correct": true}, {"label": "C", "text": "Propranolol", "correct": false}, {"label": "D", "text": "Phenytoin", "correct": false}], "correct_answer": "B. Intravenous sodium bicarbonate", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:613px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mechanism of side effect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Side effect</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>H1 <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> blockade</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sedation, weight gain</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anticholinergic action on <span class=\"customMeta\" data-dictid=\"0ad3c97c2916927771938768dcf298\">muscarinic</span> receptors</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hyperthermia</li>\n<li>Dry eyes/mouth</li>\n<li>Mydriasis (C/I in glaucoma)</li>\n<li>Urinary retention</li>\n<li>Constipation</li>\n<li>Tachycardia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increase in <span class=\"customMeta\" data-dictid=\"06eba971ce169277719884f8c62937\">serotonin</span> in the brain</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Seizure threshold reduction</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Alpha 1 <span class=\"customMeta\" data-dictid=\"0132a02ec31692777180a840765aff\">adrenergic</span> <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antagonism</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Postural hypotension</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sodium channel block</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Arrhythmia/<strong>QT prolongation</strong></li>\n<li>Bradycardia in <span class=\"customMeta\" data-dictid=\"40b788dd6916927771888a3ea6872f\">heart block</span> due to overdose</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Drug</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Antidote</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Paracetamol (acetaminophen)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>N-acetylcysteine (NAC)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Aspirin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sodium <span class=\"customMeta\" data-dictid=\"2311c3b4ac16927771831d4c919043\">bicarbonate</span> (alkalization of urine)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Benzodiazepines</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Flumazenil</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Digoxin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Digoxin-specific <span class=\"customMeta\" data-dictid=\"9d7a12cab116927771811a0079086d\">antibody</span> (ovine-derived)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Heparin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Protamine sulfate</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Iron</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Deferoxamine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Methotrexate</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Leucovorin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Opioids</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Naloxone</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Warfarin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Vitamin K, <span class=\"customMeta\" data-dictid=\"0339123c621692777203964a9056bb\">Fresh Frozen Plasma</span> (FFP)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Calcium channel blockers</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Calcium <span class=\"customMeta\" data-dictid=\"ff3235f97616927771884121a800e7\">gluconate</span> or chloride</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Beta-blockers</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Glucagon, <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">Insulin</span> + Glucose</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Organophosphates (e.g., pesticides)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Atropine, <span class=\"customMeta\" data-dictid=\"c08d723a9f16927771968c414d08e6\">Pralidoxime</span> (2-PAM)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Acetylcholinesterase inhibitors (e.g., rivastigmine)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Atropine, <span class=\"customMeta\" data-dictid=\"c08d723a9f16927771968c414d08e6\">Pralidoxime</span> (2-PAM)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tricyclic antidepressants (e.g., amitriptyline)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sodium <span class=\"customMeta\" data-dictid=\"2311c3b4ac16927771831d4c919043\">bicarbonate</span> (for arrhythmias), activated charcoal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cyanide</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sodium thiosulfate, Hydroxocobalamin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Carbon monoxide</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Oxygen (100%)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Methanol or <span class=\"customMeta\" data-dictid=\"8e2fdef08316927771877389af9cc7\">Ethylene</span> glycol</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fomepizole, Ethanol</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lithium</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sodium <span class=\"customMeta\" data-dictid=\"f7dbd0ab551692777184f9b1a73c6d\">chloride</span> (saline)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Isoniazid (INH)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pyridoxine (Vitamin B6)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dapsone</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Methylene blue</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lead</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dimercaprol (BAL), EDTA</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mercury</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dimercaprol (BAL), Penicillamine</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Arsenic</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dimercaprol (BAL), <span class=\"customMeta\" data-dictid=\"5ab75b06c21692777199dd3b72b4b1\">Succimer</span> (DMSA)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A farmer presents to you with swelling on foot and multiple discharging sinuses in the lower limb. Granules from the discharge were examined under the microscope, shown below. Which of the following is true regarding this condition?", "options": [{"label": "A", "text": "Both bacteria and fungi can be causative", "correct": true}, {"label": "B", "text": "Undergoes lymphatic spread", "correct": false}, {"label": "C", "text": "There is lymphocyte accumulation", "correct": false}, {"label": "D", "text": "Involves only superficial tissues", "correct": false}], "correct_answer": "A. Both bacteria and fungi can be causative", "question_images": ["https://image.prepladder.com/notes/dRz9Jo9XVuoWNucoAGZ41746256491.png"], "explanation_images": ["https://image.prepladder.com/notes/FvDmyfx49DiMYWBjZHj51746256562.png", "https://image.prepladder.com/notes/RagU7suxnu8Nt2Xmw5lU1746256640.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Actinomycetoma (Bacterial)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Eumycetoma (Fungal)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causative Agents</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><em>Actinomyces, Nocardia</em></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><em>Madurella, Exophiala</em></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Granule Color</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>White, yellow, red</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Black, brown</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tissue Involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Deep tissue destruction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Deep tissue involvement</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Spread</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hematogenous, but not lymphatic</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hematogenous, but not lymphatic</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Long-term antibiotics</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Antifungals, surgery</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a woman who is 4 days postpartum and experiencing tearfulness, mood swings, and occasional insomnia?", "options": [{"label": "A", "text": "Postpartum depression", "correct": false}, {"label": "B", "text": "Postpartum blues", "correct": true}, {"label": "C", "text": "Postpartum psychosis", "correct": false}, {"label": "D", "text": "Postpartum anxiety", "correct": false}], "correct_answer": "B. Postpartum blues", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/CX4DrBUkIAUiFFcmiqyi1746427228.png"], "explanation": "<p>Correct Answer B - &lt;span class=\"customMeta\" data-dictid=\"3d885759d516927771966b84bfa470\"&gt;Postpartum&lt;/span&gt; blues</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Postpartum Blues</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Postpartum Depression </strong></p>\n<p style=\"text-align:center\"><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Postpartum Psychosis</strong></p>\n<p style=\"text-align:center\"><strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Occurrence </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Affects<strong> up to 80%</strong> of women <strong>after childbirth</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Affects <strong>10- 15%</strong> of women</li>\n<li>70% risk of <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> in next pregnancy</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Incidence is about <strong>1-2 </strong>in 1000 deliveries</li>\n<li>50% risk of <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> in next pregnancy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Timing </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Onset <strong>3-5 days </strong>postpartum, <strong>resolves by days to weeks</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Within the <strong>first 6 weeks </strong>postpartum or after abortion</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Symptoms appear <strong>within 2-3 weeks</strong> <span class=\"customMeta\" data-dictid=\"3d885759d516927771966b84bfa470\">postpartum</span> and <strong>last 2-3 months</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Symptoms </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Transient symptoms such as</p>\n<ul>\n<li>Emotionally labile</li>\n<li>Insomnia</li>\n<li>Weepiness</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Loss of energy</li>\n<li>Depressed mood</li>\n<li>Loss of interest or pleasure (anhedonia)</li>\n<li>Loss of appetite</li>\n<li>Insomnia</li>\n<li>Social withdrawal</li>\n<li>Irritability</li>\n<li>Suicidal thoughts</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Initial symptoms: insomnia, tearfulness, mood lability, fatigue, followed by</p>\n<ul>\n<li>Hallucinations</li>\n<li>Delusions</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Risk Factors </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Not specific; <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to biochemical changes.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Young <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> age</li>\n<li>Antenatal depression</li>\n<li>Family history of mood disorder</li>\n<li>Unmarried status</li>\n<li>Smoking</li>\n<li>Stress</li>\n<li>Newborns in <span class=\"customMeta\" data-dictid=\"901bf573f216927771905f0abedca2\">intensive</span> care</li>\n<li>Physical or verbal abuse</li>\n<li>Serious adverse obstetrical events</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Nulliparas</li>\n<li>Obstetrical complications</li>\n<li>Family history of mood disorder</li>\n<li>History of <span class=\"customMeta\" data-dictid=\"23702653681692777196e5c0fc63cd\">psychotic</span> illness</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Supportive treatment and reassurance.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Antidepressants and <strong>psychotherapy.</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hospitalization, pharmacological treatment (lithium, antipsychotics, antidepressants), long-term psychiatric care</li>\n<li>Temporary separation from the infant and <span class=\"customMeta\" data-dictid=\"6f686e0c91169277719346f95361c8\">nursing</span> supervision may be necessary</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><img alt=\"Postpartum Depression\" data-author=\"\" data-hash=\"11709\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/CX4DrBUkIAUiFFcmiqyi1746427228.png\"/></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a cauliflower-shaped mass on the foot of a farmer that appeared after a minor injury, with microscopy revealing copper penny bodies?", "options": [{"label": "A", "text": "Chromoblastomycosis", "correct": true}, {"label": "B", "text": "Blastomycosis", "correct": false}, {"label": "C", "text": "Sporotrichosis", "correct": false}, {"label": "D", "text": "Phaeohyphomycosis", "correct": false}], "correct_answer": "A. Chromoblastomycosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/ZEpKxqWsvHOcC7A7zrwd1746256779.png", "https://image.prepladder.com/notes/48ewWluj3j607DiF8qUn1746256826.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:461px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Chromoblastomycosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causative Organisms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><em>Fonsecaea, Cladophialophora, Phialophora</em></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk Factor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Trauma (especially in farmers)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cauliflower-like <span class=\"customMeta\" data-dictid=\"0f0be4ebf11692777201b3aaf5e6fc\">verrucous</span> lesion</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Microscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Copper penny bodies (Medlar bodies/ <span class=\"customMeta\" data-dictid=\"4d81389d911692777193e1bad448a3\">muriform</span> bodies)</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Copper penny bodies\" data-author=\"NA\" data-hash=\"11572\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/Sclerotic-cells-from-footpad-tissue-samples-obtained-seven-months-after-infection_fig5_240770598\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/ZEpKxqWsvHOcC7A7zrwd1746256779.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Spread</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Slow, <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> spread</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Itraconazole, surgery if severe</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with fever, night sweats, ptosis, and bilateral facial nerve palsy. Investigations show leukocytosis and bilateral hilar lymphadenopathy. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Sarcoidosis", "correct": true}, {"label": "B", "text": "Tuberculosis", "correct": false}, {"label": "C", "text": "Lymphoma", "correct": false}, {"label": "D", "text": "Hypersensitive pneumonitis", "correct": false}], "correct_answer": "A. Sarcoidosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/k6KaJPSB6XadumdqHQ0S1745391744.png", "https://image.prepladder.com/content/ZesNh4KNvrTdPLKd9hOB1745391747.png", "https://image.prepladder.com/content/NU8SzQHK4arNAwTFnQQF1745391759.png", "https://image.prepladder.com/content/zZvyeEg0E9YupRggx9fa1745391763.png", "https://image.prepladder.com/content/ua74AFpuWdiMAfwrGsi61745391790.png", "https://image.prepladder.com/content/wj0saDG4ttiqaYw7Rnlp1745391796.png", "https://image.prepladder.com/content/wXuQntBJ7Sr8dfA54SsY1745391806.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:613px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Sarcoidosis is a chronic multisystem <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> disorder of unknown cause, characterized by the accumulation of T lymphocytes and <span class=\"customMeta\" data-dictid=\"81ec3329d0169277719261f4b61d44\">mononuclear</span> phagocytes, leading to the formation of non-caseating granulomas in various tissues of the body.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lungs (90%)</strong></p>\n<ul>\n<li>Interstitial lung disease</li>\n<li>Pulmonary fibrosis</li>\n<li>Cavitation (Rare)</li>\n<li>Pleural involvement (1-5% cases) with occasional pleural effusion</li>\n</ul>\n<p><strong>Pulmonary Symptoms: </strong>Dry cough, dyspnea, chest pain</p>\n<p> </p>\n<p><strong>Lymph Nodes (75-90%)</strong></p>\n<ul>\n<li>Bilateral <span class=\"customMeta\" data-dictid=\"28055cb4f61692777189ea3a82b1f2\">hilar lymphadenopathy</span> (hallmark)</li>\n<li>Parotid enlargement</li>\n</ul>\n<p> </p>\n<p><strong>Extrapulmonary Symptoms:</strong></p>\n<ul>\n<li><strong>Skin</strong>\n<ul>\n<li><strong>Erythema nodosum</strong> (tender red nodules, often on shins)</li>\n</ul>\n</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"James Heilman, MD\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:ENlegs.JPG\" data-tags=\"\" height=\"376\" src=\"https://image.prepladder.com/content/k6KaJPSB6XadumdqHQ0S1745391744.png\" width=\"236\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n<ul>\n<li>\n<ul>\n<li><strong>Lupus pernio</strong> (purple-blue shiny lesions on nose, cheeks, lips, and ears)</li>\n</ul>\n</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"M. Sand, D. Sand, C. Thrandorf, V. Paech, P. Altmeyer, F. G. Bechara,\" data-hash=\"\" data-license=\"CC BY 2.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Lupus_pernio_01.jpg\" data-tags=\"\" height=\"289\" src=\"https://image.prepladder.com/content/ZesNh4KNvrTdPLKd9hOB1745391747.png\" width=\"448\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Eyes: </strong>Anterior Uveitis</li>\n<li><strong>Kidneys: </strong>Hypercalcemia with or without hypercalciuria</li>\n<li><strong>Nervous System: </strong>Facial nerve palsy, Peripheral neuropathy</li>\n<li><strong>Heart: </strong>Cor pulmonale (secondary to <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> fibrosis)</li>\n</ul>\n<p><strong>Constitutional Symptoms:</strong> Fever, fatigue, night sweats, weight loss</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Syndromes Associated</strong></p>\n<p> </p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Lofgren's syndrome:</strong> Features include <span class=\"customMeta\" data-dictid=\"f0f3e105661692777187df507b1f26\">erythema</span> nodosum (painful red nodules on the shins), hilar lymphadenopathy, and <span class=\"customMeta\" data-dictid=\"b1db3c1e5d1692777195ff7cd3e282\">periarticular</span> arthritis.</li>\n<li><strong>Mikulicz syndrome: </strong>Involves <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">enlargement</span> of the parotid, submaxillary, and <span class=\"customMeta\" data-dictid=\"75089cc39e1692777199b8933bd249\">sublingual</span> glands.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histopathological Features</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Presence of <strong>non-caseating granulomas</strong> in affected organs</li>\n<li>Granulomas are often composed of <span class=\"customMeta\" data-dictid=\"ed5f81953d1692777187529a6de318\">epithelioid</span> histiocytes and giant cells (Langerhans or foreign body type)</li>\n</ul>\n<p> </p>\n<p><strong>Inclusion Bodies in Giant Cells:</strong></p>\n<ul>\n<li><strong>Schaumann bodies </strong>(calcium-protein inclusions)</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Yale Rosen\" data-hash=\"\" data-license=\"CC BY-SA 2.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Schaumann_bodies_with_crystalline_inclusions,_polarized_(6169473771).jpg\" data-tags=\"\" height=\"299\" src=\"https://image.prepladder.com/content/NU8SzQHK4arNAwTFnQQF1745391759.png\" width=\"444\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n<ul>\n<li><strong>Asteroid bodies</strong> (stellate-shaped inclusions)</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Nephron \" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Asteroid_body\" data-tags=\"\" height=\"435\" src=\"https://image.prepladder.com/content/zZvyeEg0E9YupRggx9fa1745391763.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Initial <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">Diagnostic</span> Workup</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>History and Physical Examination</strong></p>\n<ul>\n<li>Assess for <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> symptoms and <span class=\"customMeta\" data-dictid=\"728e7607f31692777187291e007a0b\">extrapulmonary</span> signs</li>\n<li>Check for <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> <span class=\"customMeta\" data-dictid=\"28055cb4f61692777189ea3a82b1f2\">hilar lymphadenopathy</span> and skin lesions</li>\n</ul>\n<p><strong>Chest Imaging</strong></p>\n<ul>\n<li>Chest X-ray (Stage 1: <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> <span class=\"customMeta\" data-dictid=\"28055cb4f61692777189ea3a82b1f2\">hilar lymphadenopathy</span> is a hallmark finding)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Laboratory Investigations</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Serum Angiotensin-Converting Enzyme (ACE)</strong></p>\n<ul>\n<li>Elevated in 60% of cases (non-specific but supportive)</li>\n</ul>\n<p><strong>Calcium Levels</strong></p>\n<ul>\n<li>Hypercalcemia due to increased 1,25-dihydroxyvitamin D production by macrophages in granulomas</li>\n</ul>\n<p><strong>Bronchoalveolar Lavage (BAL)</strong></p>\n<ul>\n<li>CD4/CD8 ratio &gt; 3.5 supports <span class=\"customMeta\" data-dictid=\"1bea5cbf1d16927771988b19241f4c\">sarcoidosis</span> (not <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> alone)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pulmonary Function Tests (PFTs)</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Restrictive Pattern</li>\n<li>Decreased FVC and TLC</li>\n<li>Normal or increased FEV1/FVC ratio</li>\n<li>Decreased DLCO (diffusion capacity for carbon monoxide)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"7\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Imaging Studies</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Chest X-Ray:</strong> Staging based on lung involvement</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Stage 0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Stage 1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bilateral hilar lymphadenopathy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Stage 2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bilateral <span class=\"customMeta\" data-dictid=\"28055cb4f61692777189ea3a82b1f2\">hilar lymphadenopathy</span> with <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> infiltrates</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Stage 3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pulmonary infiltrates only</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Stage 4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pulmonary fibrosis</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>High-Resolution CT (HRCT):</strong></p>\n<ul>\n<li>Ground-glass opacities</li>\n<li>Perilymphatic nodules</li>\n<li>Fibrotic changes</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histopathology</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tissue Biopsy (Gold Standard)</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Suzuki, Keiichi &amp; Morise, Zenichi &amp; Furuta, Shinpei &amp; Tanahashi, Yoshinao &amp; Takeura, Chinatsu &amp; Kagawa, Tadashi &amp; Ikeda, Masahiro &amp; Sugioka, Atsushi\" data-hash=\"\" data-license=\"CC BY-NC 4.0\" data-source=\"https://www.researchgate.net/figure/Histopathological-findings-show-the-presence-of-non-caseating-granuloma-with_fig3_51107722\" data-tags=\"\" height=\"362\" src=\"https://image.prepladder.com/content/ua74AFpuWdiMAfwrGsi61745391790.png\" width=\"479\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li><strong>Non-caseating granulomas</strong> in lung, <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes, or skin</li>\n<li>Exclusion of other <span class=\"customMeta\" data-dictid=\"9e1f97f6ad169277718805c2dd35c1\">granulomatous</span> diseases such as <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> (caseating granulomas) and fungal infections</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Other <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">Diagnostic</span> Tests</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gallium-67 Scintigraphy</strong></p>\n<ul>\n<li><strong>Panda Sign:</strong> Uptake in <span class=\"customMeta\" data-dictid=\"7a742b06701692777191bdca4f04a0\">lacrimal</span> and <span class=\"customMeta\" data-dictid=\"42d0553c3916927771944110a6f15b\">parotid</span> glands</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"T. RodriguesE. RochaA. Barcelos\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.semanticscholar.org/paper/Ocular-and-parotid-sarcoidosis-panda-sign.-Rodrigues-Rocha/2203e280bc3e5f4c775d68b35c9bf2ff88ea4771/figure/0\" data-tags=\"\" height=\"435\" src=\"https://image.prepladder.com/content/wj0saDG4ttiqaYw7Rnlp1745391796.png\" width=\"295\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n<ul>\n<li><strong>Lambda Sign:</strong> Uptake in <span class=\"customMeta\" data-dictid=\"625feb7e3a1692777183aa9d923cfd\">bilateral</span> hilar and right paratracheal <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes</li>\n</ul>\n<p> </p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Allard, A. &amp; Buscombe, J. &amp; Kidd, Desmond\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Panda-A-and-Lambda-B-patterns-on-gallium-scan_fig1_273743573\" data-tags=\"\" height=\"386\" src=\"https://image.prepladder.com/content/wXuQntBJ7Sr8dfA54SsY1745391806.png\" width=\"409\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n<p><strong>Positron Emission Tomography (PET)</strong></p>\n<ul>\n<li>Identifies active <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and organ involvement</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Differential Diagnosis</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Infections: Tuberculosis, fungal infections</li>\n<li>Autoimmune Disorders: Lupus, <span class=\"customMeta\" data-dictid=\"40dbde72e41692777197e59d893839\">rheumatoid</span> arthritis</li>\n<li>Malignancies: Lymphoma, metastatic carcinoma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnostic Criteria</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Compatible clinical and radiographic presentation</li>\n<li>Non-caseating granulomas on histopathology</li>\n<li>Exclusion of other <span class=\"customMeta\" data-dictid=\"9e1f97f6ad169277718805c2dd35c1\">granulomatous</span> diseases</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Irregular pitting of nails with subungual hyperkeratosis is seen in ___________.", "options": [{"label": "A", "text": "Lichen planus", "correct": false}, {"label": "B", "text": "Psoriasis", "correct": true}, {"label": "C", "text": "Atopic dermatitis", "correct": false}, {"label": "D", "text": "Alopecia areata", "correct": false}], "correct_answer": "B. Psoriasis", "question_images": ["https://image.prepladder.com/notes/spYf4mU5EBr0MlqsBqES1746256909.png"], "explanation_images": ["https://image.prepladder.com/content/SILYjmp3totT8s1ZIcwA1745391939.png", "https://image.prepladder.com/content/kODrWcVcWMQYTzOilY3d1745391922.png", "https://image.prepladder.com/content/ayvChF4WrU5sc0e0QBhe1745391915.png", "https://image.prepladder.com/notes/yv1SxhJLFnbXmUFuv6QM1746257036.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Nail Changes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Psoriasis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Irregular <strong>pitting</strong>, <strong>subungual hyperkeratosis</strong>, oil drop sign, onycholysis, <span class=\"customMeta\" data-dictid=\"2bb63f81301692777199461e9fc6f4\">splinter</span> hemorrhages</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lichen Planus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pterygium formation</strong> (wing-shaped scar), nail thinning, ridging, <span class=\"customMeta\" data-dictid=\"7ba18aa5e616927771918a45051a40\">longitudinal</span> striations</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Atopic Dermatitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Shiny, <span class=\"customMeta\" data-dictid=\"e30073048816927771830d431eabfe\">brittle</span> nails</strong>, exaggerated <span class=\"customMeta\" data-dictid=\"7ba18aa5e616927771918a45051a40\">longitudinal</span> ridging</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Alopecia Areata</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Regular, geometric pitting</strong>, <span class=\"customMeta\" data-dictid=\"29ff24181b1692777200b1e8fb47b6\">trachyonychia</span> (rough, sandpaper-like nails)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old female patient presents with fever, breathlessness, and cough with expectoration. A CT scan was done, which is shown below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Consolidation with air bronchogram", "correct": true}, {"label": "B", "text": "Mediastinal mass", "correct": false}, {"label": "C", "text": "Pleural effusion", "correct": false}, {"label": "D", "text": "Diaphragmatic hernia", "correct": false}], "correct_answer": "A. Consolidation with air bronchogram", "question_images": ["https://image.prepladder.com/content/TyP2XflMzTvOfRUDr6GM1745391929.png"], "explanation_images": ["https://image.prepladder.com/content/zNKP45gF309RVK1mS3Hv1745392042.png", "https://image.prepladder.com/content/0dMEvEIwvtzZd9OCfX3C1745392037.png", "https://image.prepladder.com/notes/C6288DPAF86aGCXozWOc1746271133.png", "https://image.prepladder.com/content/guMKb9mzXo6ZB4tPvrkg1745392022.png", "https://image.prepladder.com/notes/9o9hA1NQ2ea6QrSEnFju1746271207.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Investigation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Initial Evaluation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Clinical suspicion based on patient history and physical examination.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Chest Radiography</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>The most <strong>important initial test</strong> for <span class=\"customMeta\" data-dictid=\"1000989d33169277719652247cd559\">pneumonia</span> diagnosis.</li>\n<li>Shows <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> infiltrate; indicates type (lobar, interstitial, unilateral, or bilateral).</li>\n<li>Cannot reliably <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> between bacterial and non-bacterial causes.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Paks M, Silverstone L, Knipe H, et al. Lobar pneumonia. Reference article, Radiopaedia.org (Accessed on 14 Dec 2024) https://doi.org/10.53347/rID-26886\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/lobar-pneumonia\" data-tags=\"\" height=\"434\" src=\"https://image.prepladder.com/content/zNKP45gF309RVK1mS3Hv1745392042.png\" width=\"438\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>CT Scan</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>More accurate than a chest X-ray.</li>\n<li>Focal dense <span class=\"customMeta\" data-dictid=\"990cbfd3111692777194c6967ee125\">opacification</span> of an entire <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> occurs, with relative sparing of the large airways. Associated findings may include <span class=\"customMeta\" data-dictid=\"c70bf4cd73169277718868a5f3904b\">ground-glass</span> opacities in a <span class=\"customMeta\" data-dictid=\"82ded933641692777191ee421dc094\">lobar</span> or <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">segmental</span> pattern, indicating areas of partial involvement or atelectasis.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Al Khateeb A, Lobar pneumonia. Case study, Radiopaedia.org (Accessed on 14 Dec 2024) https://doi.org/10.53347/rID-50499\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/lobar-pneumonia\" data-tags=\"\" height=\"491\" src=\"https://image.prepladder.com/content/0dMEvEIwvtzZd9OCfX3C1745392037.png\" width=\"594\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>Image shows left upper lung <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> <span class=\"customMeta\" data-dictid=\"b1357efd5116927771859dfba380e7\">consolidation</span> of <span class=\"customMeta\" data-dictid=\"b2dafdf91e16927771884f1d4b5107\">heterogenous</span> density, with<strong> multiple air bronchograms, </strong>and small left pleural effusion</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Laboratory Tests</strong></p>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Complete Blood Count (CBC):\n\t\t\t\t<ul>\n<li>Look for <span class=\"customMeta\" data-dictid=\"515cde208f1692777191112bb2ff9e\">leukocytosis</span> (leftward shift) as a sign of infection.</li>\n<li>Leukopenia may indicate a poor prognosis.</li>\n</ul>\n</li>\n<li>Inflammatory Biomarkers: ESR and <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> phase reactants to assess severity.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Sputum Analysis</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Sputum <span class=\"customMeta\" data-dictid=\"f0347e3a7a1692777188cf90c50d6f\">Gram</span> <span class=\"customMeta\" data-dictid=\"b29a1a16ab1692777199ede1c6e28b\">stain</span> and culture critical for suspected <span class=\"customMeta\" data-dictid=\"82ded933641692777191ee421dc094\">lobar</span> pneumonia.</li>\n<li>Sputum culture is the <strong>most specific <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> test</strong> for identifying the <span class=\"customMeta\" data-dictid=\"f616aee08b169277718361438e1a91\">causative</span> organism.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Influenza Testing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Recommended during <strong>winter months </strong>due to the risk of co-infection with pneumonia.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Patient Stratification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Use CURB-65 and the <span class=\"customMeta\" data-dictid=\"1000989d33169277719652247cd559\">pneumonia</span> severity index to determine <span class=\"customMeta\" data-dictid=\"277d6f3ee2169277718938e321258f\">hospitalization</span> needs.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Additional Testing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Hospitalized patients: <span class=\"customMeta\" data-dictid=\"5353537f861692777199e48431cd88\">sputum</span> culture, blood culture, and/or <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> <span class=\"customMeta\" data-dictid=\"782b31281a1692777181708484c1d1\">antigen</span> testing before antibiotics.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Invasive Procedures</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Thoracocentesis, bronchoscopy, pleural biopsy, and pleural fluid culture are rarely performed.</li>\n<li><strong>Open lung <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> is the ultimate specific <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> test.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n<p><strong>References:</strong></p>\n<ul><li>↳ Harrison's Principles of Internal Medicine, 21st Edition, Page: 1011, 1012, 2200.</li><li>↳ Typical Bacterial Pneumonia - StatPearls - NCBI Bookshelf</li><li>↳ Lobar pneumonia | Radiology Reference Article | Radiopaedia.org</li></u\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old woman presents to you with hair loss for the past three months. She tested positive for COVID-19 eight months ago. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Tinea capitis", "correct": false}, {"label": "B", "text": "Telogen effluvium", "correct": true}, {"label": "C", "text": "Trichotillomania", "correct": false}, {"label": "D", "text": "Female – pattern androgenetic alopecia", "correct": false}], "correct_answer": "B. Telogen effluvium", "question_images": ["https://image.prepladder.com/notes/MJAF8TyNDCSIdwGahQm01746257129.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:528px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Telogen Effluvium</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Trigger</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Stress, infection (COVID-19), surgery, postpartum, drugs</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2-3 months after stressor</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hair Loss Pattern</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Diffuse thinning, shedding &gt;100 hairs/day</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Scalp Examination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal, no <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> or scarring</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Self-limiting, resolves in 6-12 months</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female patient with a body mass index of 30 kg/m2 presents to you with a lesion on the neck, as shown below. Which of the following conditions is the most likely to be suffering from?", "options": [{"label": "A", "text": "Hypothyroidism", "correct": false}, {"label": "B", "text": "Metabolic syndrome", "correct": true}, {"label": "C", "text": "Addision’s disease", "correct": false}, {"label": "D", "text": "Hyperparathyroidism", "correct": false}], "correct_answer": "B. Metabolic syndrome", "question_images": ["https://image.prepladder.com/notes/i1K2ul6f5y9BXdi80gFv1746257220.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:615px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Metabolic Syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Key Components</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Insulin resistance, obesity, hypertension, hyperlipidemia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Signs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Acanthosis nigricans, central obesity, skin tags</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Chronic <strong>hyperinsulinemia</strong> stimulates <span class=\"customMeta\" data-dictid=\"616d85c57416927771875ef23f6751\">epidermal</span> growth, leading to <strong>Acanthosis Nigricans</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Associated Risks</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Type 2 diabetes, <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> disease</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lifestyle changes (weight loss, exercise), Metformin</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Choose the correct statement regarding the telomerase theory of ageing:", "options": [{"label": "A", "text": "Telomere stability is associated with ageing", "correct": false}, {"label": "B", "text": "Abnormal telomerase activation is associated with ageing", "correct": false}, {"label": "C", "text": "Decreased telomere length is associated with ageing", "correct": true}, {"label": "D", "text": "Increased telomere length is associated with ageing", "correct": false}], "correct_answer": "C. Decreased telomere length is associated with ageing", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - Decreased &lt;span class=\"customMeta\" data-dictid=\"b9d804af7716927772001ebdb234b1\"&gt;telomere&lt;/span&gt; length is associated with ageing\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old patient is undergoing tooth extraction for dental caries. Which of the following does not require prophylaxis against infective endocarditis?", "options": [{"label": "A", "text": "Prior history of endocarditis", "correct": false}, {"label": "B", "text": "Atrial septal defect", "correct": true}, {"label": "C", "text": "Unrepaired cyanotic heart disease", "correct": false}, {"label": "D", "text": "Prosthetic heart valves", "correct": false}], "correct_answer": "B. Atrial septal defect", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Most Common Organism</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Community-acquired native <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> endocarditis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Staphylococcus aureus</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Healthcare-associated native <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> endocarditis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Streptococci</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Endocarditis in <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">injection</span> drug users (Right side)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Staphylococcus aureus</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Endocarditis in <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">injection</span> drug users (Left side)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Staphylococcus aureus</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Most common organism causing <span class=\"customMeta\" data-dictid=\"c936e2cd131692777196b1d877f678\">prosthetic</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> endocarditis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Enterococci and <span class=\"customMeta\" data-dictid=\"71c203268816927771994a1fffd645\">Staphylococcus</span> aureus</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Most common group of organisms causing early <span class=\"customMeta\" data-dictid=\"c936e2cd131692777196b1d877f678\">prosthetic</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> <span class=\"customMeta\" data-dictid=\"33812b7bb0169277718707b5473b45\">endocarditis</span> (&lt;12 months after surgery)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Coagulase-negative <span class=\"customMeta\" data-dictid=\"0520f732541692777199acffcfd9ba\">staphylococci</span> (CoNS)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Late <span class=\"customMeta\" data-dictid=\"c936e2cd131692777196b1d877f678\">prosthetic</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> <span class=\"customMeta\" data-dictid=\"33812b7bb0169277718707b5473b45\">endocarditis</span> (&gt;12 months after surgery)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Streptococci</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Acute <span class=\"customMeta\" data-dictid=\"802328b229169277719000601489eb\">infective</span> endocarditis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Staphylococcus aureus</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Subacute <span class=\"customMeta\" data-dictid=\"802328b229169277719000601489eb\">infective</span> endocarditis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Streptococcus viridans</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cardiovascular implantable electronic device (CIED)-associated endocarditis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Enterococci and <span class=\"customMeta\" data-dictid=\"cc520058161692777185da0fc11a45\">Coagulase-negative Staphylococci</span> (CoNS)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Culture-negative endocarditis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>HACEK organisms</p>\n<p>Coxiella burnetii</p>\n<p>Bartonella</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child presents with recurrent chest infections and abdominal pain. There is a history of delayed growth and bone problems causing facial changes. On examination, he had icterus and mild splenomegaly. Electrophoresis is given below. What is the likely diagnosis?", "options": [{"label": "A", "text": "Beta thalassemia", "correct": true}, {"label": "B", "text": "HbC disease", "correct": false}, {"label": "C", "text": "Sickle cell disease", "correct": false}, {"label": "D", "text": "Acute coronary disease", "correct": false}], "correct_answer": "A. Beta thalassemia", "question_images": ["https://image.prepladder.com/notes/rsBWoi5SbR7qW0xnkjHX1746424574.png"], "explanation_images": ["https://image.prepladder.com/notes/425Nl9xLgYYTryifbfch1746424640.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Beta Thalassemias</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Major (Transfusion-dependent)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Intermedia (Non-transfusion-dependent)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Minor (Trait or Carrier)</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Genotype</strong></p>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Homozygous:</p>\n<ul>\n<li>β⁰/β⁰</li>\n<li>β⁰/β⁺</li>\n<li>β⁺/β⁺</li>\n</ul>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Variable:</p>\n<ul>\n<li>β⁰/β⁺ or β⁺/β⁺ or β⁰/β or β⁺/β</li>\n</ul>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Heterozygous:</p>\n<ul>\n<li>β⁰/β or β⁺/β</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Laboratory Findings</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Severe <span class=\"customMeta\" data-dictid=\"d09dc1da551692777192706b7f882e\">microcytic</span> <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> with target cells (Hb 3–4 g/dL)</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Moderate <span class=\"customMeta\" data-dictid=\"d09dc1da551692777192706b7f882e\">microcytic</span> anemia</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mild <span class=\"customMeta\" data-dictid=\"d09dc1da551692777192706b7f882e\">microcytic</span> anemia</p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Hemoglobin Electrophoresis</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>HbA₂ (5% or more);</li>\n<li>HbF (up to 95%); No HbA</li>\n</ul>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>HbA₂ (4% or more);</li>\n<li>HbF (up to 50%)</li>\n</ul>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>HbA₂ (4% or more);</li>\n<li>HbF (up to 5%)</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents to the emergency department with a history of ingestion of ten tablets of paracetamol. He has developed oliguria, and liver function tests show deranged values. Which of the following can be used in the management of this condition?", "options": [{"label": "A", "text": "N-acetylcysteine", "correct": true}, {"label": "B", "text": "Dopamine", "correct": false}, {"label": "C", "text": "Ursodeoxycholic acid", "correct": false}, {"label": "D", "text": "Furosemide", "correct": false}], "correct_answer": "A. N-acetylcysteine", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A pregnant lady with 34 weeks of gestation presented to the OPD with the following lab reports: LDH- 700 IU/L, Platelets – 75,000/mm3, Serum bilirubin- 1.5mg/dL, SGOT-200 U/L, SGPT-150U/L, and BP -140/96 mm Hg. Her coagulation profile and renal function tests are normal. What is the diagnosis? LDH- Lactate dehydrogenase SGOT- Serum glutamic-oxaloacetic transaminase / AST- Aspartate transaminase SGPT- Serum glutamic pyruvic transaminase / ALT- Alanine transaminase", "options": [{"label": "A", "text": "HELLP syndrome", "correct": true}, {"label": "B", "text": "Acute fatty liver of pregnancy", "correct": false}, {"label": "C", "text": "Viral hepatitis", "correct": false}, {"label": "D", "text": "Intrahepatic cholestasis", "correct": false}], "correct_answer": "A. HELLP syndrome", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>HELLP Syndrome:</strong></p>\n<p>Rare <span class=\"customMeta\" data-dictid=\"8a6b09beac1692777184b08a2b5766\">complication</span> of Preeclampsia, which usually occurs in the third <span class=\"customMeta\" data-dictid=\"2c20f0f1dd169277720029d29458d5\">trimester</span> of pregnancy</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Features:</strong></p>\n<ul>\n<li>H- Hemolysis</li>\n<li>EL- Elevated Liver enzymes</li>\n<li>LP- Low Platelets</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk factors:</strong></p>\n<ul>\n<li>HELLP in prior pregnancy, age &gt;35, multiparous, history of diabetes, <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Symptoms: </strong></p>\n<ul>\n<li>RUQ pain, headache, blurred vision, nausea, vomiting, edema</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Maternal complications:</strong></p>\n<ul>\n<li>Blood <span class=\"customMeta\" data-dictid=\"58c17961c71692777184ab55a9c4df\">clotting</span> problems, DIC</li>\n<li>Kidney failure</li>\n<li>Liver failure</li>\n<li>Pulmonary edema</li>\n<li>Eclampsia</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fetal complications:</strong></p>\n<ul>\n<li>Preterm birth</li>\n<li>Growth restriction</li>\n<li>Respiratory distress</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment:</strong></p>\n<ul>\n<li>Majority of patients develop eclampsia- MgSO4 to prevent seizures</li>\n<li>Antihypertensives to control BP</li>\n<li>If &lt;34 weeks, Corticosteroids for lung maturity</li>\n<li>Definitive treatment: <span class=\"customMeta\" data-dictid=\"a35c217ec416927772009a7f3b20f4\">Termination</span> of pregnancy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>HELLP Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Obstetric Cholestasis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Acute <span class=\"customMeta\" data-dictid=\"bc6cd9a9f9169277720261812ea113\">Fatty</span> Liver of Pregnancy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Viral Hepatitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Onset in Pregnancy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mid to late</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Late</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Late</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Variable</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Differentiating Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Signs of liver failure</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pruritus (elevated <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> acids)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Signs of liver failure</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Signs of liver failure</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>AST (U/L)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>≤300</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>≤200</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>200-800</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2000+</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Bilirubin (mg/dL)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1-4</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1-5</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4-10</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>5-20</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fever</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Yes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Platelets</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fibrinogen</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>D-dimer</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prothrombin Time</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Prolonged</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Prolonged</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hemolysis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Yes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Why do neoplastic cells utilise Warburg metabolism?", "options": [{"label": "A", "text": "It decreases glucose utilization by neoplastic cells", "correct": false}, {"label": "B", "text": "It forms metabolic intermediates which are needed for cell growth and multiplication", "correct": true}, {"label": "C", "text": "It provides more energy in the form of increased ATP production", "correct": false}, {"label": "D", "text": "It prevents apoptosis and makes the cancer immortal", "correct": false}], "correct_answer": "B. It forms metabolic intermediates which are needed for cell growth and multiplication", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female patient with a negative urine pregnancy test presents to you with galactorrhea. An MRI was done, which revealed a large pituitary tumor. If the patient is not willing to undergo surgery, which of the following is the best drug for treatment?", "options": [{"label": "A", "text": "Bromocriptine", "correct": true}, {"label": "B", "text": "Promethazine", "correct": false}, {"label": "C", "text": "Octreotide", "correct": false}, {"label": "D", "text": "Clozapine", "correct": false}], "correct_answer": "A. Bromocriptine", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Mostly idiopathic; can be associated with <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">MEN</span> 1 or RET gene mutations.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Microadenomas: &lt;1 cm, often asymptomatic.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Macroadenomas: &gt;1 cm, may cause <span class=\"customMeta\" data-dictid=\"d01e44abab16927772010db8725801\">visual field</span> defects, headaches, and neurological symptoms.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Galactorrhea, amenorrhea, <span class=\"customMeta\" data-dictid=\"e259c6641e1692777190c1be1c1842\">infertility</span> (women)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Erectile dysfunction, <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"987affaf2e1692777191dd88f2037e\">libido</span> (men)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Headaches, visual disturbances (e.g., <span class=\"customMeta\" data-dictid=\"3b17da47ce16927771831d5dde3af3\">bitemporal</span> hemianopia, <span class=\"customMeta\" data-dictid=\"1458c330411692777186cd49bb6a30\">diplopia</span> in large tumors).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated <span class=\"customMeta\" data-dictid=\"760a997a7b1692777196db9355b82a\">prolactin</span> levels, <span class=\"customMeta\" data-dictid=\"7ce7bcb2f316927771938e0bea7f4d\">MRI</span> for tumor imaging.</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dopamine agonists: <strong>Bromocriptine, <span class=\"customMeta\" data-dictid=\"c0cb3cd6081692777183c51f11e182\">Cabergoline</span> (first-line)</strong> to reduce <span class=\"customMeta\" data-dictid=\"760a997a7b1692777196db9355b82a\">prolactin</span> <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> and tumor size.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cabergoline: Preferred; fewer side effects.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Surgical: If resistant to or intolerant of <span class=\"customMeta\" data-dictid=\"9194a239ed1692777186bfe41c0e87\">dopamine</span> agonists, or with significant complications.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Radiotherapy: For resistant cases.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents to you with an irregularly irregular pulse of 120/minute and a pulse deficit of 20. Which of the following would be the jugular venous pressure (JVP) finding?", "options": [{"label": "A", "text": "Absent p wave", "correct": false}, {"label": "B", "text": "Absent a wave", "correct": true}, {"label": "C", "text": "Cannon a wave", "correct": false}, {"label": "D", "text": "Raised JVP with normal waveform", "correct": false}], "correct_answer": "B. Absent a wave", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/myQoBTyoUWW6PwMDLvOq1745393319.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:680px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Atrial Fibrillation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Characterized by <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> automatic <span class=\"customMeta\" data-dictid=\"0c2d898b0b1692777202c5d43d5e78\">firing</span> and multiple re-entry circuits.</li>\n<li>Atria beat rapidly and ineffectively; ventricles activated irregularly</li>\n</ul>\n<ul>\n<li>Produces an <strong>\"irregularly irregular\" pulse</strong></li>\n<li>Palpitations, syncope, and breathlessness can be present</li>\n<li>Asymptomatic AF: Can present as <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"1c07a1135f1692777187f547678386\">embolism</span> and stroke</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>ECG Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>QRS Complexes: <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">Irregular</span> but normal</li>\n<li>P Waves: Absent; <span class=\"customMeta\" data-dictid=\"3c8a051a89169277718256c92278c5\">baseline</span> may show<strong> <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> <span class=\"customMeta\" data-dictid=\"6ae0ac06031692777202699c4c75a0\">fibrillation</span> waves</strong></li>\n<li>Ventricular Rate:\n\t\t\t\t<ul>\n<li>Fast at onset (120-160 beats/min)</li>\n<li>Slower in chronic AF due to medication effects and AV nodal fatigue</li>\n</ul>\n</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"PeaBrainC\" data-hash=\"\" data-license=\"\" data-source=\"https://commons.wikimedia.org/wiki/File:Atrial_Fibrillation_in_two_leads.jpg\" data-tags=\"\" height=\"481\" src=\"https://image.prepladder.com/content/myQoBTyoUWW6PwMDLvOq1745393319.png\" width=\"452\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>JVP </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Absent a wave</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Paroxysmal Atrial Fibrillation</strong></p>\n<ul>\n<li><strong>First-line Therapy: Beta-blockers</strong> are effective in patients with CAD, hypertension, and heart failure.</li>\n<li>Class <span class=\"customMeta\" data-dictid=\"e02c7dfea516927771894c64e8013a\">Ic</span> Drugs: <strong>Propafenone or flecainide</strong> to prevent episodes (not for patients with CAD or LV dysfunction).</li>\n<li>Class III Drugs:\n\t\t\t\t<ul>\n<li><strong>Amiodarone</strong>: Most effective but with significant side effects; used when other treatments fail.</li>\n<li><strong>Dronedarone</strong>: Alternative to amiodarone; contraindicated in heart failure.</li>\n</ul>\n</li>\n<li><strong>Rate Control: Digoxin and verapamil </strong>for AV <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> <span class=\"customMeta\" data-dictid=\"63bda90e3516927771848cbb473f04\">conduction</span> slowing, but not for AF prevention.</li>\n<li>Catheter Ablation: Considered for patients with <span class=\"customMeta\" data-dictid=\"d4c88fcae71692777186aa1c32423a\">drug-resistant</span> AF; prevents AF in ~75% of cases but may have complications.</li>\n</ul>\n<p><strong>Persistent Atrial Fibrillation</strong></p>\n<ul>\n<li><strong>Rhythm Control</strong>:\n\n\t\t\t\t<ul>\n<li><strong>Cardioversion</strong>: Electrical or pharmacological (e.g., <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> flecainide or amiodarone).</li>\n<li>Timing: Immediate if AF &lt;48 hours; <span class=\"customMeta\" data-dictid=\"9beeeb58f6169277718129acb7bd01\">anticoagulation</span> required if AF ≥48 hours.</li>\n<li>Prophylactic <strong>Amiodarone</strong>: To reduce <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> risk.</li>\n</ul>\n</li>\n<li><strong>Rate Control</strong>:\n\t\t\t\t<ul>\n<li>Medications: <strong>Digoxin, β-blockers, or rate-limiting <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> antagonists (verapamil, diltiazem)</strong>.</li>\n<li>Combination Therapy: <strong>Digoxin with β-blockers</strong>; avoid combining <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> antagonists with β-blockers.</li>\n<li>Pace and Ablate: Permanent <span class=\"customMeta\" data-dictid=\"e70797a893169277719467eb262506\">pacemaker</span> with AV nodal block for <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> AF.</li>\n</ul>\n</li>\n</ul>\n<p><strong>Thromboprophylaxis</strong></p>\n<ul>\n<li>Anticoagulation: Required for stroke prevention due to blood <span class=\"customMeta\" data-dictid=\"ea73ce564216927771989ea1aa2c3d\">stasis</span> in the left atrium.\n\t\t\t\t<ul>\n<li><strong>Warfarin</strong>: INR target of 2.0–3.0; start 4 weeks prior to cardioversion.</li>\n<li><strong>DOACs: Rivaroxaban, apixaban, edoxaban, and dabigatran </strong>as alternatives to warfarin; no monitoring needed.</li>\n</ul>\n</li>\n<li>Risk Assessment:\n\t\t\t\t<ul>\n<li><strong>CHA2DS2-VASc Score</strong>: For stroke risk; anticoagulate if <strong>score ≥2</strong>.</li>\n<li>HAS-BLED Score: For <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> risk; monitor patients with score ≥3.</li>\n</ul>\n</li>\n<li>Aspirin: Not recommended due to low <span class=\"customMeta\" data-dictid=\"7f80be61231692777187391e91e867\">efficacy</span> in preventing <span class=\"customMeta\" data-dictid=\"acd7af7f74169277718736b038fb02\">embolic</span> stroke.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:601px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>CHA2DS2-VASc stroke risk scoring system for AF</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Points</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Parameters</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Score</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>C</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Congestive heart failure</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>H</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Hypertension history</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>A2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Age (≥75 years)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>D</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Diabetes mellitus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>S2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Previous stroke or <span class=\"customMeta\" data-dictid=\"a6cf2c3dc51692777200ef7fb22f69\">transient</span> ischemic attack (TIA)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>V</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Vascular disease</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>A</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Age (65-74 years)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Sc</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Sex category (female)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Maximum total score</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>9 points</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A woman at 26 weeks of gestation presents for routine evaluation. On examination, fundal height corresponds to 24 weeks. Ultrasonography revealed decreased amniotic fluid. Which of the following conditions would have led to this presentation?", "options": [{"label": "A", "text": "Renal agenesis", "correct": true}, {"label": "B", "text": "Tracheoesophageal fistula", "correct": false}, {"label": "C", "text": "Cardiac abnormalities", "correct": false}, {"label": "D", "text": "Ureteral stricture", "correct": false}], "correct_answer": "A. Renal agenesis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:619px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Threshold</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Amniotic Fluid Volume</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal: 500–2000 mL</p>\n<p>Oligohydramnios: &lt;500 mL</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Amniotic Fluid Index (AFI)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>≤ 5 cm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Single Deepest Vertical Pocket (SDVP)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>≤ 2 cm</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Polyhydramnios</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Oligohydramnios </strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fetal Anomalies</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anencephaly</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Renal agenesis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Esophageal atresia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Posterior urethral valves</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Duodenal atresia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ureteral stricture</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tracheoesophageal fistula</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fetal growth restriction (IUGR)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Twin-Related</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Twin-to-twin <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">transfusion</span> syndrome (recipient twin)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Twin-to-twin <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">transfusion</span> syndrome (donor twin)</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Maternal Conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Diabetes mellitus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Maternal hypertension</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hypothyroidism</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Preeclampsia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Autoimmune diseases (e.g., SLE) affecting <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> perfusion</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Placental Factors</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Chorioangioma</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Placental insufficiency</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Placental abruption</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Genetic/Metabolic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bartter syndrome (salt-wasting <span class=\"customMeta\" data-dictid=\"b06dd1c5181692777193f14f3ed7d7\">nephropathy</span> causing <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> polyuria)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>_</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Growth/Development</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hydrops fetalis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Post-term pregnancy</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An elderly patient presents with anemia and hemoglobinuria. Investigations reveal increased bilirubin and lactate dehydrogenase. The peripheral smear image is given below. Which of the following is associated with this?", "options": [{"label": "A", "text": "Splenomegaly", "correct": false}, {"label": "B", "text": "Mechanical second heart valve", "correct": true}, {"label": "C", "text": "Increased HbA2", "correct": false}, {"label": "D", "text": "Goitre", "correct": false}], "correct_answer": "B. Mechanical second heart valve", "question_images": ["https://image.prepladder.com/notes/MSs5Y4CBwLOro9TqZQDz1746424844.png"], "explanation_images": ["https://image.prepladder.com/content/N9ueAaP1cGoVfZ4aD75h1745393254.png"], "explanation": "<p>Correct Answer B - Mechanical second heart valv\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Causes of Hemolysis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Extravascular Hemolysis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Intravascular hemolysis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hereditary spherocytosis</li>\n<li>Sickle cell anemia</li>\n<li>Thalassemia</li>\n<li><strong>G6PD deficiency</strong></li>\n<li>Warm <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">autoimmune</span> <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">hemolytic</span> <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">anemia</span> (AIHA)</li>\n<li>Cold <span class=\"customMeta\" data-dictid=\"793dda05ac1692777180345347d49c\">agglutinin</span> type AIHA</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Paroxysmal Nocturnal <span class=\"customMeta\" data-dictid=\"ddeb334a351692777188795bb090ef\">Hemoglobinuria</span> (PNH)</li>\n<li>Microangiopathic <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">Hemolytic</span> <span class=\"customMeta\" data-dictid=\"53bee2a41216927771814d7ec3a67f\">Anemia</span> (MAHA)- HUS, TTP, DIC</li>\n<li>Paroxysmal cold hemoglobinuria/Cold <span class=\"customMeta\" data-dictid=\"9fea3db5bb16927771885315f60b70\">hemolysin</span> type AIHA</li>\n<li><strong>G6PD <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> </strong></li>\n<li><strong>Mechanical heart valve</strong>s</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A type 1 diabetic mother is on magnesium sulfate infusion post-cesarean section for preeclampsia. She develops delirium and is drowsy. She has a respiratory rate of 10/min, a random blood glucose level of 240 mg/dL, oliguria, and bilaterally absent knee reflex. What is the cause of her condition?", "options": [{"label": "A", "text": "Magnesium sulfate toxicity", "correct": true}, {"label": "B", "text": "Diabetic ketoacidosis", "correct": false}, {"label": "C", "text": "Eclampsia", "correct": false}, {"label": "D", "text": "Diabetes insipidus", "correct": false}], "correct_answer": "A. Magnesium sulfate toxicity", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Serum <span class=\"customMeta\" data-dictid=\"4d7ed0baae169277719199f6e9ab7b\">Magnesium</span> Level</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Effect</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>5–9 mg/dL</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Therapeutic range</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>9 mg/dL</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Loss of patellar reflexes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>12 mg/dL</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Respiratory depression occurs at ~12 mEq/L (14.4 mg/dL) due to muscle paralysis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>30 mg/dL</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Cardiac arrest</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the type of hymen shown in the image below.", "options": [{"label": "A", "text": "Imperforate hymen", "correct": false}, {"label": "B", "text": "Semilunar hymen", "correct": false}, {"label": "C", "text": "Septate hymen", "correct": true}, {"label": "D", "text": "Annular hymen", "correct": false}], "correct_answer": "C. Septate hymen", "question_images": ["https://image.prepladder.com/notes/alRjbDNtkIFnFbGRYEq11746422767.png"], "explanation_images": ["https://image.prepladder.com/content/OxZEw6YHUmT2ABk8m3bK1745393618.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:762px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Hymen Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Imperforate (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Menarche with <span class=\"customMeta\" data-dictid=\"1d84248e9f16927771850f8b75c26a\">cyclic</span> pain, and amenorrhea.</li>\n<li>Abdominal pain.</li>\n<li>Cryptomenorrhea: <span class=\"customMeta\" data-dictid=\"3a03cad6c616927771925038b55989\">Menstrual</span> blood is produced but not expelled from the body.</li>\n<li>Hematocolpos: Bulging, bluish <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> at the introitus.</li>\n<li>Hematometra: Accumulation of <span class=\"customMeta\" data-dictid=\"3a03cad6c616927771925038b55989\">menstrual</span> blood in the uterus.</li>\n<li>Hematosalpinx: Accumulation of blood in the <span class=\"customMeta\" data-dictid=\"efc83dab2c1692777202b5d1d06c4f\">fallopian</span> tubes.</li>\n<li><strong>Differential Diagnosis: <span class=\"customMeta\" data-dictid=\"a6260fa86416927772008d36bd7e5f\">Transverse</span> <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">Vaginal</span> <span class=\"customMeta\" data-dictid=\"d783117d991692777198108af42c05\">septum</span> - </strong>\n<ul>\n<li>Incomplete <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> of the <span class=\"customMeta\" data-dictid=\"0b31da4446169277719292c6fbfad2\">Müllerian</span> ducts and <span class=\"customMeta\" data-dictid=\"2942e9d19616927772014161ee8f70\">urogenital</span> sinus.</li>\n<li>A <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> band of tissue at various levels (low, mid, or high) that divides the <span class=\"customMeta\" data-dictid=\"8537d8358c169277720162f2f6971b\">vagina</span> horizontally.</li>\n<li>Normal external genitalia; <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> examination reveals a <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> or band within the <span class=\"customMeta\" data-dictid=\"8537d8358c169277720162f2f6971b\">vagina</span> on palpation.</li>\n<li>Mx: <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">Surgical</span> <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> of the septum.</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Incision and drainage.</li>\n<li>Avoid needle aspiration, as this can lead to infection.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Microperforate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Very small opening, which may cause <span class=\"customMeta\" data-dictid=\"3a03cad6c616927771925038b55989\">menstrual</span> irregularities or difficulty with <span class=\"customMeta\" data-dictid=\"1b61c0a12a16927772000f29e3e7e5\">tampon</span> use.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Surgical <span class=\"customMeta\" data-dictid=\"2afbd932801692777190be690704b3\">incision</span> followed by <span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\">excision</span> of the hymen.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Septate</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Band of tissue dividing the <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> opening</li>\n<li>Dyspareunia.</li>\n<li>If one side of a <span class=\"customMeta\" data-dictid=\"55f411a4ea1692777198d8f2de73b0\">septate</span> <span class=\"customMeta\" data-dictid=\"8537d8358c169277720162f2f6971b\">vagina</span> is obstructed, it can lead to <span class=\"customMeta\" data-dictid=\"4756da02d81692777193706979151e\">mucocolpos</span> or hematocolpos.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Excision.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cribriform (sieve)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Multiple small openings allow for <span class=\"customMeta\" data-dictid=\"3a03cad6c616927771925038b55989\">menstrual</span> flow but often cause discomfort or difficulties with intercourse.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Annular (Option D)</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Menstrual irregularities.</li>\n<li>Difficulty in <span class=\"customMeta\" data-dictid=\"1b61c0a12a16927772000f29e3e7e5\">tampon</span> placement/ intercourse.</li>\n</ul>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Naviculare (boatlike)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Semilunar/ Crescentric (Option B) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Crescent-shaped opening, with tissue along the lower portion of the <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> opening, leaving a large central opening.</li>\n<li>Seen in Childhood/Adolescence.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "While discharging a patient who underwent a vesicovaginal fistula repair, which of the following would you recommend?", "options": [{"label": "A", "text": "Sexual abstinence for 3 months and avoid pregnancy for a year", "correct": true}, {"label": "B", "text": "Sexual abstinence for 3 weeks and avoid pregnancy for 6 months", "correct": false}, {"label": "C", "text": "Sexual abstinence for 6 weeks and avoid pregnancy for a year", "correct": false}, {"label": "D", "text": "Sexual abstinence for 6 months and avoid pregnancy for 6 years", "correct": false}], "correct_answer": "A. Sexual abstinence for 3 months and avoid pregnancy for a year", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "All of the following statements regarding neutrophil extracellular trapping (NET) are true, except?", "options": [{"label": "A", "text": "It is detected in blood during sepsis", "correct": false}, {"label": "B", "text": "It is produced in response to bacterial infection", "correct": false}, {"label": "C", "text": "Mitochondrial DNA is seen", "correct": true}, {"label": "D", "text": "It is chromatin with antibacterial enzymes", "correct": false}], "correct_answer": "C. Mitochondrial DNA is seen", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/mVULhxNSBqIt4Ch4u8U81746425058.png", "https://image.prepladder.com/content/XdsyO9I3GFnIHtPSa4M31745393696.png"], "explanation": "<p>Correct Answer C - Mitochondrial DNA\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is an absolute contraindication for inserting the device shown in the image below?", "options": [{"label": "A", "text": "Menstruation", "correct": false}, {"label": "B", "text": "Trophoblastic disease", "correct": true}, {"label": "C", "text": "Immediately after delivery", "correct": false}, {"label": "D", "text": "Ruptured condom during intercourse", "correct": false}], "correct_answer": "B. Trophoblastic disease", "question_images": ["https://image.prepladder.com/content/c6P7UhrqBN0OW7Xidf4e1745393740.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Contraindications for IUCD insertion</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Trophoblastic disease</li>\n<li>Distorted <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> (fibroids, <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> anomalies)</li>\n<li>Ongoing <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> infection</li>\n<li>Undiagnosed <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">genital</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> bleeding</li>\n<li>Suspected pregnancy</li>\n<li>Severe dysmenorrhea</li>\n<li>STIs - current or recurrent</li>\n<li>Wilson disease (for <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> IUCDs)</li>\n<li>Breast cancer (for hormone-containing IUCDs)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with a history of chronic liver disease presents with abdominal distension, jaundice, and pruritis. Ascitic fluid analysis revealed a neutrophil count of 650 per cubic mm. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Spontaneous bacterial peritonitis", "correct": true}, {"label": "B", "text": "Malignant ascites", "correct": false}, {"label": "C", "text": "Tubercular ascites", "correct": false}, {"label": "D", "text": "Intestinal obstruction", "correct": false}], "correct_answer": "A. Spontaneous bacterial peritonitis", "question_images": ["https://image.prepladder.com/notes/rqX5geOPVMioMPcTeVs71746271406.png"], "explanation_images": ["https://image.prepladder.com/notes/rd21wUnBoXEYe0aprGLa1746271473.png", "https://image.prepladder.com/content/CVJSla89W2eOeyk94Pqz1745394065.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:760px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>A severe <span class=\"customMeta\" data-dictid=\"8a6b09beac1692777184b08a2b5766\">complication</span> of ascites, characterised by <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">spontaneous</span> infection of the <span class=\"customMeta\" data-dictid=\"2a9ff5941c1692777182f4c00d6f69\">ascitic fluid</span> without an <span class=\"customMeta\" data-dictid=\"b02812a466169277719090c2d27868\">intra-abdominal</span> source.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causative organism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Escherichia <span class=\"customMeta\" data-dictid=\"cd0a7121a516927771846d8f5248bb\">coli</span> (most common)</strong> and other gut bacteria.</li>\n<li>Gram-positive bacteria (Streptococcus viridans, Staphylococcus aureus, and Enterococcus)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Source of infection</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><img alt=\"Source of infection of Peritonitis\" data-author=\"\" data-hash=\"11626\" data-license=\"\" data-source=\"\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/rd21wUnBoXEYe0aprGLa1746271473.png\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Worsening of ascites</li>\n<li>Fever, nausea, vomiting</li>\n<li>Increase in <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> girth</li>\n<li>Encephalopathy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ascitic fluid analysis shows:</p>\n<ul>\n<li><strong>Turbid appearance</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Piña-Pedraza, J.P. &amp; Álvarez-Avalos, L &amp; Vargas-Espinosa, J.M. &amp; Salcedo-Gómez, A &amp; Carranza-Madrigal, Jaime\" data-hash=\"\" data-license=\"CC BY NC ND 4.0\" data-source=\"https://www.researchgate.net/figure/A-Ascitic-fluid-with-a-turbid-aspect-obtained-from-the-first-paracentesis-B-Ascitic_fig4_281194792\" data-tags=\"\" height=\"369\" src=\"https://image.prepladder.com/content/CVJSla89W2eOeyk94Pqz1745394065.png\" width=\"462\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n<ul>\n<li><strong>Neutrophil count &gt;250/μL</strong></li>\n<li>Culture and <span class=\"customMeta\" data-dictid=\"f0347e3a7a1692777188cf90c50d6f\">gram</span> satins reveal the <span class=\"customMeta\" data-dictid=\"f616aee08b169277718361438e1a91\">causative</span> organisms</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>IV 3rd generation cephalosporins (cefotaxime) for 5 days</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prevention </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Paracentesis within 12 hours of hospital admission </strong></li>\n<li><strong>Norfloxacin administration</strong> (cirrhotic patients with an episode of SBP)</li>\n<li>Quinolone <span class=\"customMeta\" data-dictid=\"ff6b4f4d491692777181a02bad075e\">antibiotic</span> <span class=\"customMeta\" data-dictid=\"bc36e9b9381692777196b5f9a2f79c\">prophylaxis</span> (recurrent episodes of SBP in <span class=\"customMeta\" data-dictid=\"d4607865bb1692777201a35341db81\">variceal</span> bleeding).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 20-year-old woman is evaluated for primary infertility. Hysterosalpingography was done and reveals the findings shown below. What is the anomaly seen in the image?", "options": [{"label": "A", "text": "Septate uterus", "correct": true}, {"label": "B", "text": "Uterine didelphys", "correct": false}, {"label": "C", "text": "Bicornuate uterus", "correct": false}, {"label": "D", "text": "Unicornuate uterus", "correct": false}], "correct_answer": "A. Septate uterus", "question_images": ["https://image.prepladder.com/notes/ed3Ns3i2e1jfyNty6Px31746422885.png"], "explanation_images": ["https://image.prepladder.com/notes/69b3cW5zPz7o1HdBnIHC1746422973.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:721px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Müllerian <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">Uterine</span> Anomaly</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Septate Uterus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Incomplete <span class=\"customMeta\" data-dictid=\"797daba8ca1692777197dc9f8d3a4a\">resorption</span> of the <span class=\"customMeta\" data-dictid=\"d783117d991692777198108af42c05\">septum</span> between the Müllerian ducts, resulting in a <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> <span class=\"customMeta\" data-dictid=\"d783117d991692777198108af42c05\">septum</span> within the <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> cavity.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Recurrent first-trimester miscarriages, Infertility.</p>\n<ul>\n<li>DD: <span class=\"customMeta\" data-dictid=\"826d69375c16927771838a850d37fe\">Bicornuate</span> <span class=\"customMeta\" data-dictid=\"0c847ca20416927772011b3397c2fd\">uterus</span> has an intercomual angle &gt;105 degrees during hysterosalpingography.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Hysteroscopic <span class=\"customMeta\" data-dictid=\"ee124319051692777192ed4ba34edc\">metroplasty</span> to remove the septum.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Bicornuate <span class=\"customMeta\" data-dictid=\"0c847ca20416927772011b3397c2fd\">Uterus</span> (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Incomplete <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> of the Müllerian ducts, leading to a heart-shaped <span class=\"customMeta\" data-dictid=\"0c847ca20416927772011b3397c2fd\">uterus</span> with two cavities.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Higher <span class=\"customMeta\" data-dictid=\"17cd3771bb1692777190950c142dbe\">incidence</span> of infertility, endometriosis, and dysmenorrhea.</p>\n<ul>\n<li>Requires 3D USG/ MRI to <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> from <span class=\"customMeta\" data-dictid=\"55f411a4ea1692777198d8f2de73b0\">Septate</span> Uterus</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Metroplasty in severe cases. Often managed conservatively.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Didelphys <span class=\"customMeta\" data-dictid=\"0c847ca20416927772011b3397c2fd\">Uterus</span> (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Complete non-fusion of the Müllerian ducts, two separate uteri, and often two cervices.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Preterm labor, Menstrual irregularities.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Managed conservatively, <span class=\"customMeta\" data-dictid=\"ee124319051692777192ed4ba34edc\">Metroplasty</span> if symptomatic.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Unicornuate <span class=\"customMeta\" data-dictid=\"0c847ca20416927772011b3397c2fd\">Uterus</span> - </strong>Noncommunicating</p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Partial development of one Müllerian duct, resulting in a single-horned uterus.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Cyclic <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> pain may be misdiagnosed as an adnexal mass.</p>\n<p>Ectopic pregnancy, <span class=\"customMeta\" data-dictid=\"ac9f7287191692777196e8c02d1f3d\">Preterm</span> labor</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Prophylactic <span class=\"customMeta\" data-dictid=\"13508a2eb21692777184b37534a0ae\">cerclage</span> placement or <span class=\"customMeta\" data-dictid=\"183d374ac91692777196c63c850299\">progesterone</span> supplementation to prevent <span class=\"customMeta\" data-dictid=\"ac9f7287191692777196e8c02d1f3d\">preterm</span> birth.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Arcuate Uterus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Mild <span class=\"customMeta\" data-dictid=\"cdb5523e491692777190f8bc3775ff\">indentation</span> at the top of the <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> due to minor incomplete <span class=\"customMeta\" data-dictid=\"797daba8ca1692777197dc9f8d3a4a\">resorption</span> of the septum.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Generally <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> and normal <span class=\"customMeta\" data-dictid=\"11e24b369816927771974383c7e17c\">reproductive</span> outcomes.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Reassurance and conservative management.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A pregnant woman with no other comorbid conditions develops preeclampsia. She enquires about the cause of her condition. The doctor explains that it is due to the failure of the invasion of:", "options": [{"label": "A", "text": "Spiral artery by villous trophoblasts", "correct": false}, {"label": "B", "text": "Radial artery by cytotrophoblasts", "correct": false}, {"label": "C", "text": "Spiral artery by extravillous trophoblasts", "correct": true}, {"label": "D", "text": "Arcuate artery by extravillous trophoblasts", "correct": false}], "correct_answer": "C. Spiral artery by extravillous trophoblasts", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/XUbjQuMfODFrH6k5Y1Ii1745394822.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:774px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Normal Pregnancy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Pregnancy-Induced <span class=\"customMeta\" data-dictid=\"45372f6c361692777189ff3209e642\">Hypertension</span> (PIH)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Placentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Extravillous trophoblasts invade the <span class=\"customMeta\" data-dictid=\"0b34a9891d16927771998a84595013\">spiral</span> arteries of the <span class=\"customMeta\" data-dictid=\"0c847ca20416927772011b3397c2fd\">uterus</span> around week 20.</li>\n<li>This invasion widens the <span class=\"customMeta\" data-dictid=\"0b34a9891d16927771998a84595013\">spiral</span> arteries.</li>\n<li>The widening enhances <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> to the placenta.</li>\n<li>This is known as secondary placentation.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Incomplete invasion of the <span class=\"customMeta\" data-dictid=\"0b34a9891d16927771998a84595013\">spiral</span> arteries by extravillous trophoblasts.</li>\n<li>Persistent narrow vessels with <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> and <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> ischemia.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Immune Response</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>T-helper 2 cells dominate, promoting <span class=\"customMeta\" data-dictid=\"1a6d065f851692777189ba5533d1ef\">humoral</span> <span class=\"customMeta\" data-dictid=\"4f9ee631c21692777189b1e0cdc91c\">immunity</span> and tolerance of the <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> antigens.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>A shift towards T-helper 1 cell activity.</li>\n<li>Increasing the production of pro-inflammatory cytokines (TNF-α, γ-interferon, IL-2).</li>\n<li>Contributing to endothelial dysfunction.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Endothelial Function</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Maintains normal <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> tone and permeability, regulating <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> and preventing inappropriate clotting.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Endothelial cells become dysfunctional, leading to vasoconstriction, increased <span class=\"customMeta\" data-dictid=\"1c7103a9b516927771955682b6aaa4\">permeability</span> (edema), and <span class=\"customMeta\" data-dictid=\"ba6b77f29316927771807350f86ce2\">activation</span> of the <span class=\"customMeta\" data-dictid=\"42f1e4deb8169277718412c0681a54\">coagulation</span> cascade.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Angiogenic Balance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pro-angiogenic factors (VEGF, PlGF, TGF-β) promote <span class=\"customMeta\" data-dictid=\"72c06d2cc71692777183b1cbaf5bae\">blood vessel</span> growth.</li>\n<li>Anti-angiogenic factors (sFlt-1, sEng) <span class=\"customMeta\" data-dictid=\"6b3de87b7c16927771901326efbcd2\">inhibit</span> <span class=\"customMeta\" data-dictid=\"72c06d2cc71692777183b1cbaf5bae\">blood vessel</span> growth.</li>\n<li>A balance between these factors is essential for proper <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> development and function.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Imbalance occurs with elevated production of anti-angiogenic factors (sFlt-1, sEng).</li>\n<li>Reduced levels of pro-angiogenic factors are observed.</li>\n<li>sFlt-1 binds to and deactivates <span class=\"customMeta\" data-dictid=\"acec296d051692777201ef9eae77fa\">VEGF</span> and PlGF.</li>\n<li>sEng inhibits TGF-β signaling.</li>\n<li>This <span class=\"customMeta\" data-dictid=\"2cc844bc9c1692777189739abf1dc5\">imbalance</span> leads to endothelial <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> and impaired angiogenesis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Blood Pressure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Blood pressure remains within the <span class=\"customMeta\" data-dictid=\"f3ae79c18b1692777193468a9fd567\">normal range</span> due to the vasodilatory effects of pregnancy hormones</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hypertension occurs after 20 weeks of pregnancy, characterized by <span class=\"customMeta\" data-dictid=\"263ee5444e1692777183a7e8e704da\">blood pressure</span> over 140/90 mmHg.</li>\n<li>It results from vasoconstriction, endothelial dysfunction, and heightened sensitivity to vasopressors.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A woman with an obstetric score of G2P1 comes to the clinic at 14 weeks of gestation for her antenatal checkup. A uterine artery Doppler was suggested by the doctor. What would it detect?", "options": [{"label": "A", "text": "Early-onset preeclampsia", "correct": true}, {"label": "B", "text": "Late-onset preeclampsia", "correct": false}, {"label": "C", "text": "Fetal growth restriction", "correct": false}, {"label": "D", "text": "Placenta accreta", "correct": false}], "correct_answer": "A. Early-onset preeclampsia", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient underwent a cystoscopy, which showed multiple yellow-white plaques in the trigone of the bladder. The histopathology image is given below. What is the diagnosis?", "options": [{"label": "A", "text": "Interstitial cystitis", "correct": false}, {"label": "B", "text": "Malakoplakia", "correct": true}, {"label": "C", "text": "Polypoid cystitis", "correct": false}, {"label": "D", "text": "Acute cystitis", "correct": false}], "correct_answer": "B. Malakoplakia", "question_images": ["https://image.prepladder.com/content/tQU7KdfIsG2qLXFXwc8v1745394557.png"], "explanation_images": ["https://image.prepladder.com/notes/5zxpYrAhdvFCWXjHlgrP1746425332.png"], "explanation": "<p>Correct Answer B - Malakoplakia</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Malakoplakia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Common Pathogen</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><em>Escherichia coli</em> (most common), other Gram-negative bacteria</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Histopathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Von Hansemann cells (large, foamy histiocytes) with Michaelis-Gutmann bodies (PAS-positive inclusions).</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Characteristic Inclusions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Michaelis-Gutmann bodies (basophilic <span class=\"customMeta\" data-dictid=\"45e0bd1529169277719054d85830ce\">intracytoplasmic</span> inclusions)</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"Michaelis Gutmann bodies\" data-author=\"Mustafa Goksel, M.D\" data-hash=\"11679\" data-license=\"NA\" data-source=\"https://www.pathologyoutlines.com/topic/bladdermalakoplakia.html\" data-tags=\"May2025\" height=\"270\" src=\"https://image.prepladder.com/notes/5zxpYrAhdvFCWXjHlgrP1746425332.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Staining</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Positive <span class=\"customMeta\" data-dictid=\"3b007026bd16927771997ae809b603\">staining</span> with <strong>periodic acid-Schiff (PAS), von Kossa, and Perl’s stains</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Associated Conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Immunocompromised states, such as organ transplantation, HIV, diabetes, malignancy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Organ Involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Predominantly <span class=\"customMeta\" data-dictid=\"2fd33fb2ac16927771889901daadeb\">genitourinary</span> tract, but can affect multiple organ systems</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Antibiotics (fluoroquinolones, trimethoprim-sulfamethoxazole), possible <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> excision</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Requires treatment; may lead to complications if untreated; variable course with potential relapses.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Laboratory investigations of a patient being evaluated for jaundice show elevated bilirubin and alkaline phosphatase levels. Levels of the remaining liver enzymes are normal. What is the likely diagnosis?", "options": [{"label": "A", "text": "Obstructive jaundice", "correct": true}, {"label": "B", "text": "Hemolytic jaundice", "correct": false}, {"label": "C", "text": "Hepatic jaundice", "correct": false}, {"label": "D", "text": "Prehepatic jaundice", "correct": false}], "correct_answer": "A. Obstructive jaundice", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:737px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Prehepatic Jaundice</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Hepatic Jaundice</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Posthepatic (Obstructive) Jaundice</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Hemolysis (e.g., <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">hemolytic</span> anemia, malaria) </strong> <strong>(Option B)</strong></li>\n<li>Sickle cell disease</li>\n<li>G6PD deficiency</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Liver diseases (e.g., <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> hepatitis, cirrhosis, <span class=\"customMeta\" data-dictid=\"0751b802aa169277718100e38a1276\">alcoholic</span> liver disease)</li>\n<li>Liver tumors</li>\n<li>Drug-induced liver injury</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Bile <span class=\"customMeta\" data-dictid=\"6198b5f22b16927771867e4ef8108f\">duct</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> (e.g., gallstones, pancreatic cancer, cholangiocarcinoma, strictures, tumors)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Increased <span class=\"customMeta\" data-dictid=\"903370f259169277718385f6060dd7\">breakdown</span> of red blood cells</li>\n<li>Excessive <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> production</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Impaired <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> <span class=\"customMeta\" data-dictid=\"5bf9387ee91692777185685e187e76\">conjugation</span> and <span class=\"customMeta\" data-dictid=\"0f7653c9ef1692777187deaa35f749\">excretion</span> due to liver dysfunction</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Blocked <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> flow</li>\n<li>Accumulation of conjugated <span class=\"customMeta\" data-dictid=\"2d60c5a677169277718325a811dcf1\">bilirubin</span> in bloodstream</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Yellowing of skin and sclera</li>\n<li>Anemia</li>\n<li>Fatigue</li>\n<li>Splenomegaly</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Yellowing of skin and sclera</li>\n<li>Fatigue</li>\n<li>Nausea</li>\n<li>Hepatomegaly</li>\n<li>Pruritus</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Yellowing of skin and sclera</li>\n<li>Pale stools</li>\n<li>Dark urine</li>\n<li>Pruritus</li>\n<li>Hepatomegaly</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Bilirubin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated unconjugated (indirect) bilirubin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated unconjugated and conjugated (direct) bilirubin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated conjugated (direct) bilirubin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Liver <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">Enzyme</span> Values</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>AST, ALT: Normal or slightly elevated</li>\n<li>ALP: Normal</li>\n<li>GGT: Normal</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>AST, ALT: Markedly elevated</li>\n<li>ALP: Elevated</li>\n<li>GGT: Elevated</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>AST, ALT: Mildly elevated</li>\n<li>ALP: Markedly elevated</li>\n<li>GGT: Elevated</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prothrombin time (PT)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal Prolonged PT</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Prolonged PT</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Prolonged PT</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Urine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal or slightly dark <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> due to <span class=\"customMeta\" data-dictid=\"7a1ae24f701692777187a7f60bbd9f\">excess</span> urobilinogen</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dark <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> (due to increased conjugated bilirubin)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Dark <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> (due to conjugated bilirubin)</li>\n<li>Pale stools (due to <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> excretion)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "While conducting a delivery, you perform the maneuver shown below. Following this, there is incomplete separation of the placenta and massive hemorrhage. What is your next step in management?", "options": [{"label": "A", "text": "Start oxytocin infusion and wait for spontaneous delivery of the placenta", "correct": false}, {"label": "B", "text": "Uterine massage", "correct": false}, {"label": "C", "text": "Arrange for blood and use Crede's method for placental delivery", "correct": false}, {"label": "D", "text": "Manual removal of placenta", "correct": true}], "correct_answer": "D. Manual removal of placenta", "question_images": ["https://image.prepladder.com/notes/dDzCSFdninobN1kwdP8D1746423173.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Causes of Primary PPH</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Factors increasing risk </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Uterine <span class=\"customMeta\" data-dictid=\"d4d4e36d2416927771828288897bf3\">Atony</span> (Most common)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>The inability of the <span class=\"customMeta\" data-dictid=\"0c847ca20416927772011b3397c2fd\">uterus</span> to contract effectively after delivery leads to a soft and boggy <span class=\"customMeta\" data-dictid=\"0c847ca20416927772011b3397c2fd\">uterus</span> and continuous <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> from the <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> site.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Grand multiparity</li>\n<li>Overdistension of the uterus: Multiple pregnancies, hydramnios, large baby Malnutrition, and anemia</li>\n<li>Antepartum hemorrhage: <span class=\"customMeta\" data-dictid=\"5276da31d11692777195f0e82f5e1d\">Placenta</span> previa and <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> abruption</li>\n<li>Prolonged labour</li>\n<li>Anesthesia</li>\n<li>Oxytocin use</li>\n<li>Uterine malformations</li>\n<li>Other factors: Obesity, h/o PPH, advanced <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> age (over 40 years), tocolytics and <span class=\"customMeta\" data-dictid=\"4d7ed0baae169277719199f6e9ab7b\">magnesium</span> sulfate</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Retained Tissue</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Prevents proper <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> contraction, causing primary PPH with continued <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> and incomplete contraction.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Although more commonly associated with secondary PPH, retained <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> fragments can also be a cause of primary PPH.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Trauma to the <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">genital</span> tract</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Cervical, vaginal, or <span class=\"customMeta\" data-dictid=\"befda305051692777195a95ee0695a\">perineal</span> <span class=\"customMeta\" data-dictid=\"1717bdb5d21692777200d45e31ceed\">tears</span> are a significant cause of primary PPH. This type of <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> occurs despite a well-contracted uterus.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Assisted deliveries</li>\n<li>Rapid labor</li>\n<li>Large babies</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Thrombin (Coagulopathy)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Involves disorders of blood clotting, which are a less common cause of PPH. They can be <span class=\"customMeta\" data-dictid=\"0f0b2969921692777180de24f0b0c0\">acquired</span> or congenital.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Placental abruption</li>\n<li>Jaundice in pregnancy</li>\n<li>Thrombocytopenic purpura</li>\n<li>Severe pre-eclampsia</li>\n<li>HELLP syndrome</li>\n<li>Intrauterine device (IUD)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Traumatic <span class=\"customMeta\" data-dictid=\"3d885759d516927771966b84bfa470\">Postpartum</span> Hemorrhage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Atonic <span class=\"customMeta\" data-dictid=\"3d885759d516927771966b84bfa470\">Postpartum</span> Hemorrhage</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Trauma to the <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">genital</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> (e.g., cervix, vagina, perineum, episiotomy, <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> rupture, hematomas)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Inadequate <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> <span class=\"customMeta\" data-dictid=\"ca2289e348169277718516017eb2ba\">contraction</span> and <span class=\"customMeta\" data-dictid=\"b7eab06f1a1692777197e0b50983e5\">retraction</span> after <span class=\"customMeta\" data-dictid=\"5276da31d11692777195f0e82f5e1d\">placenta</span> separation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Prevalence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>20% of cases of <span class=\"customMeta\" data-dictid=\"3d885759d516927771966b84bfa470\">postpartum</span> hemorrhage</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>80% of cases of <span class=\"customMeta\" data-dictid=\"3d885759d516927771966b84bfa470\">postpartum</span> hemorrhage</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Common Risk Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Operative delivery (forceps, vacuum), episiotomy, <span class=\"customMeta\" data-dictid=\"3c6bfcae8c1692777184ceb5d2efc3\">cesarean</span> section, rapid labor</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Grand multiparity, overdistension of uterus, anemia, <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> malformations</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Uterus Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Uterus is well contracted despite bleeding</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Uterus is flabby, not contracting properly</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Repair of lacerations, removal of hematomas, and possible <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> intervention</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Uterine massage, <span class=\"customMeta\" data-dictid=\"7e1c459d2b1692777194da47cd13b3\">oxytocin</span> infusion, <span class=\"customMeta\" data-dictid=\"5cce80cb00169277718310c4eccb27\">bimanual</span> compression, <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> intervention if necessary</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Blood Loss Control</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Bleeding is from injured vessels (episiotomy, ruptured uterus, etc.)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Bleeding is from uncompressed <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> sinuses due to lack of contraction</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Associated Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Hematomas, <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> rupture, infection, blood loss from <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> wounds</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Shock, anemia, <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> infections, DIC (disseminated <span class=\"customMeta\" data-dictid=\"837d6227d81692777190a063ea2cd4\">intravascular</span> coagulation)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following measures is associated with an increased life span?", "options": [{"label": "A", "text": "Regular moderate exercise for 30 min", "correct": false}, {"label": "B", "text": "Decrease stress", "correct": false}, {"label": "C", "text": "Decreasing calorie intake by 30%", "correct": true}, {"label": "D", "text": "Pharmacological intervention with proton pump inhibitors", "correct": false}], "correct_answer": "C. Decreasing calorie intake by 30%", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/oxfkho1QkLR3G1ak8n4z1746425430.png"], "explanation": "<p>Correct Answer C - Decreasing &lt;span class=\"customMeta\" data-dictid=\"5f526a682c16927771831cac5b3711\"&gt;calorie&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"6cdcd39cf2169277719068e247e38d\"&gt;intake&lt;/span&gt; by 30%</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Insulin and IGF-1 Signaling</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>IGF-1, produced in response to growth hormone, mimics <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> signalling, promoting an <span class=\"customMeta\" data-dictid=\"3e0d247aa916927771812684526ac0\">anabolic</span> state, cell growth, and replication.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sirtuins</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>These are<strong> NAD-dependent deacetylases</strong> that help adapt to stressors like food <span class=\"customMeta\" data-dictid=\"0a5bb4dd4116927771860470a5e991\">deprivation</span> and DNA damage.</li>\n<li>They promote <span class=\"customMeta\" data-dictid=\"59a954e1ed1692777191c7f591d4ba\">longevity</span> by regulating genes that reduce <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> activity, apoptosis, and <span class=\"customMeta\" data-dictid=\"60d563fe241692777194203742bf5b\">oxidative</span> damage.</li>\n<li>Sirtuins also improve <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> sensitivity and <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> metabolism.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A woman presents with fever, arthralgia, ulcers, fatigue for the past six months, and new-onset hematuria. Urine examination reveals RBC casts and proteinuria. What is the likely diagnosis?", "options": [{"label": "A", "text": "Acute interstitial nephritis", "correct": false}, {"label": "B", "text": "Post-streptococcal glomerulonephritis", "correct": false}, {"label": "C", "text": "Lupus nephritis", "correct": true}, {"label": "D", "text": "IgA nephropathy", "correct": false}], "correct_answer": "C. Lupus nephritis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female patient collapses soon after delivery. There is profuse bleeding and features of disseminated intravascular coagulation (DIC). Which of the following is the most likely etiology?", "options": [{"label": "A", "text": "Amniotic fluid embolism", "correct": true}, {"label": "B", "text": "Postpartum hemorrhage", "correct": false}, {"label": "C", "text": "Peripartum cardiomyopathy", "correct": false}, {"label": "D", "text": "Rupture of the uterus", "correct": false}], "correct_answer": "A. Amniotic fluid embolism", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:627px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Amniotic fluid or <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> debris enters the <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> circulation, triggering a <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> response.</li>\n<li>Leads to <span class=\"customMeta\" data-dictid=\"1b798ee2c21692777183440eb9102c\">cardiorespiratory</span> collapse and <span class=\"customMeta\" data-dictid=\"09376c06ef16927771848108fd8f70\">coagulopathy</span> (DIC).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Sudden onset of <span class=\"customMeta\" data-dictid=\"9402185d4b1692777189cb62891ff1\">hypotension</span> </strong>or <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> arrest.</li>\n<li>Respiratory <span class=\"customMeta\" data-dictid=\"afafb9026e1692777186e3dd168fa8\">distress</span> and gasping for air.</li>\n<li><strong>Profuse <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> due to coagulopathy/DIC.</strong></li>\n<li>Potential seizures or altered consciousness.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Timing</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Most cases occur during labor,<strong> immediately postpartum,</strong> or within 30 minutes of delivery.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Triad</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Hemodynamic collapse.</strong></li>\n<li>Respiratory compromise.</li>\n<li>Disseminated <span class=\"customMeta\" data-dictid=\"837d6227d81692777190a063ea2cd4\">intravascular</span> coagulation<strong> (DIC).</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "You are examining a multigravida in the second stage of labor for the past two hours. On examination, contractions are adequate, and the cervix is dilated with the head at station 0 with molding 2+ and caput 2+. The sagittal suture is in the right occipitotransverse position. The fetal heart rate is 140 beats/minute. Which of the following is carried out for the management of this patient?", "options": [{"label": "A", "text": "Midpelvic forceps", "correct": false}, {"label": "B", "text": "Vacuum-assisted delivery", "correct": false}, {"label": "C", "text": "Wait for an hour for spontaneous labor", "correct": false}, {"label": "D", "text": "Lower segment cesarean section", "correct": true}], "correct_answer": "D. Lower segment cesarean section", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A primigravida presents to the labor room at 40 weeks of gestation with lower abdominal pain. She has been in labor for 3 hours. Which of the following will determine if she is in active labor?", "options": [{"label": "A", "text": "Fetal head 5/5 palpable on abdominal examination", "correct": false}, {"label": "B", "text": "Two contractions lasting for 10 seconds in 10 minutes", "correct": false}, {"label": "C", "text": "More than 5 cm cervical dilatation with complete effacement", "correct": true}, {"label": "D", "text": "Rupture of membranes", "correct": false}], "correct_answer": "C. More than 5 cm cervical dilatation with complete effacement", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Contractions</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>First Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Onset of labor to full <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> <span class=\"customMeta\" data-dictid=\"29a08d8f9216927771869ed797367e\">dilatation</span> (10 cm).</p>\n<p> </p>\n<ul>\n<li><strong>Latent Phase: </strong>Early <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> changes with slower progress.</li>\n<li><strong>Active Phase: </strong>Faster <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> <span class=\"customMeta\" data-dictid=\"29a08d8f9216927771869ed797367e\">dilatation</span> (≥5 cm) with regular contractions.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Cervical <span class=\"customMeta\" data-dictid=\"29a08d8f9216927771869ed797367e\">dilatation</span> and <span class=\"customMeta\" data-dictid=\"dc0035cd191692777187b9b8b2af69\">effacement</span> occur.</li>\n<li>Intermittent painful <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> contractions.</li>\n<li>\"Show\" (blood-stained mucus) is common.</li>\n<li>Active labor starts at <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> <span class=\"customMeta\" data-dictid=\"29a08d8f9216927771869ed797367e\">dilatation</span> ≥5 cm with regular contractions.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Latent Phase: </strong>Irregular and mild.</p>\n<p><strong>Active Phase:</strong> Regular; 3–5 min apart, lasting ~45 seconds.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Second Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>From complete <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> <span class=\"customMeta\" data-dictid=\"29a08d8f9216927771869ed797367e\">dilatation</span> (10 cm) to <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> delivery.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Begins after complete <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> dilation.</li>\n<li>Ends with the delivery of the baby.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Strong and frequent; 2–3 minutes apart.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Third Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>From <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> delivery to <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> expulsion.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Placental separation and expulsion occur.</li>\n<li>Average duration: 5–15 minutes.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mild <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> contractions to aid <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> expulsion.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fourth Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Observation for at least 1 hour after <span class=\"customMeta\" data-dictid=\"797686400a16927771956b27d401ff\">placental</span> expulsion.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Monitoring for <span class=\"customMeta\" data-dictid=\"3d885759d516927771966b84bfa470\">postpartum</span> <span class=\"customMeta\" data-dictid=\"4642acfc0c16927771880b34fa5174\">hemorrhage</span> and <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> contraction.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Uterine contractions continue, aiding hemostasis.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Please identify the area in the image below that appears blue in color:", "options": [{"label": "A", "text": "Obstetric outlet", "correct": false}, {"label": "B", "text": "Anatomical outlet", "correct": false}, {"label": "C", "text": "Pelvic inlet", "correct": false}, {"label": "D", "text": "Midpelvis", "correct": true}], "correct_answer": "D. Midpelvis", "question_images": ["https://image.prepladder.com/notes/Gzu2JEQ5l7m3OZahFfIS1746423588.png"], "explanation_images": ["https://image.prepladder.com/content/E1Iw6wROlF0OSAYgvFT11745395676.png", "https://image.prepladder.com/notes/c9NWZaKenPZWiLLQ9Xr51746423704.png", "https://image.prepladder.com/content/iUR4MSl1u0AjBOsq04vT1745395694.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>True Pelvis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Criteria to diagnose contracted pelvis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pelvic inlet</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Obstetric <span class=\"customMeta\" data-dictid=\"2421c657771692777185af1b7b59c3\">conjugate</span> &lt;10 cm</li>\n<li>Greatest <span class=\"customMeta\" data-dictid=\"a6260fa86416927772008d36bd7e5f\">transverse</span> <span class=\"customMeta\" data-dictid=\"afb15e4a331692777186e495b370a1\">diameter</span> &lt;12 cm</li>\n<li>Diagonal <span class=\"customMeta\" data-dictid=\"2421c657771692777185af1b7b59c3\">conjugate</span> &lt;11 cm</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Midpelvis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The sum of the interischial <span class=\"customMeta\" data-dictid=\"6ecc9fc8e416927771993c575ccc1e\">spinous</span> and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"862a709fba1692777198c35e274398\">sagittal</span> diameters measuring 13 cm.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pelvic outlet</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>An interischial <span class=\"customMeta\" data-dictid=\"93b7b2cfd31692777201efc538e5a2\">tuberous</span> <span class=\"customMeta\" data-dictid=\"afb15e4a331692777186e495b370a1\">diameter</span> of 8 cm indicates contraction.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is a post-mortem finding seen in the lung after the death of a patient from COVID-19 after a week?", "options": [{"label": "A", "text": "Fresh and old intra-alveolar hemorrhage", "correct": false}, {"label": "B", "text": "Thick layer of fibrin", "correct": true}, {"label": "C", "text": "Perivascular cuffing", "correct": false}, {"label": "D", "text": "Pulmonary artery hypertrophy with increased resistance", "correct": false}], "correct_answer": "B. Thick layer of fibrin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - Thick\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female patient presented with fatigue and a history of piles. Routine complete blood count analysis showed a haemoglobin of 9 g/dL, an MCV of 60 fL, and an RBC count of 5.2 million. A peripheral smear is given below. Which of the following is the next best investigation for this patient?", "options": [{"label": "A", "text": "HbA2 levels", "correct": false}, {"label": "B", "text": "Serum ferritin levels", "correct": true}, {"label": "C", "text": "Serum folate levels", "correct": false}, {"label": "D", "text": "Serum homocysteine levels", "correct": false}], "correct_answer": "B. Serum ferritin levels", "question_images": ["https://image.prepladder.com/content/zJxuNakhJ5KBiSiXJEox1745395614.png"], "explanation_images": [], "explanation": "<p>Correct Answer B - Serum &lt;span class=\"customMeta\" data-dictid=\"91d0e4c6fa16927772025f96b44b27\"&gt;ferritin&lt;/span&gt; levels</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Investigations for IDA</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Iron Study</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Interpretation in Iron <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">Deficiency</span> Anemia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Serum Ferritin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low (&lt; 30 ng/mL) indicates depleted iron stores.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Serum Iron (Fe)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low levels are seen in iron <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> anemia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Total Iron Binding Capacity (TIBC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased TIBC reflects the increased capacity of <span class=\"customMeta\" data-dictid=\"d404d819f41692777200b686a0759e\">transferrin</span> to bind iron in response to low iron stores.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Red Cell Distribution Width (RDW)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased RDW is often seen in iron <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> anemia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Bone Marrow Aspiration and Iron Staining</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Confirmatory test</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type of Anemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Serum Iron</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Transferrin saturation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Serum Ferritin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>TIBC</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Sideroblastic Anemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">High</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">High</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">High</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Low</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Iron Deficiency Anemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Low</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Low</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Low</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">High</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Anemia of Chronic Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Low</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Low</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">High</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Low</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Hemolytic Anemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">High</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Low</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">High</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Low</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What will be the level of the uterus on postpartum day 2?", "options": [{"label": "A", "text": "Two finger breadths below umbilicus", "correct": true}, {"label": "B", "text": "One finger breadth below umbilicus", "correct": false}, {"label": "C", "text": "Three finger breadths below umbilicus", "correct": false}, {"label": "D", "text": "Four finger breadths below umbilicus", "correct": false}], "correct_answer": "A. Two finger breadths below umbilicus", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:609px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Time Following Delivery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Weight</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Immediately After Delivery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Uterus corresponds to 20 weeks of gestation.</li>\n<li>Fundus lies just below the umbilicus.</li>\n<li>Lochia rubra (bright red discharge).</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1000 g</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>48 Hours Post-Delivery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Myometrial <span class=\"customMeta\" data-dictid=\"2a4713707c1692777190062b13e806\">involution</span> starts.</li>\n<li>Fundal height decreases by 1 finger <span class=\"customMeta\" data-dictid=\"c6a728793d1692777183f8bab2d772\">breadth</span> (1 cm) per day.</li>\n<li><strong>Uterus lies at two finger breadths below the umbilicus.</strong></li>\n<li>Lochia rubra continues.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>_</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>1 Week Post-Delivery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Rapid involution.</li>\n<li>Fundus lies midway between the <span class=\"customMeta\" data-dictid=\"c0c9f9bbda1692777201f1fd5464cb\">umbilicus</span> and <span class=\"customMeta\" data-dictid=\"48b6a0a5fb1692777199da12372b14\">symphysis</span> pubis.</li>\n<li>Lochia <span class=\"customMeta\" data-dictid=\"8fc2f5e23316927771989ab10ac305\">serosa</span> (pinkish-brown discharge).</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>500 g</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>2 Weeks Post-Delivery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Uterus becomes a <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> organ.</li>\n<li>Fundus no longer palpable.</li>\n<li>Lochia <span class=\"customMeta\" data-dictid=\"8fc2f5e23316927771989ab10ac305\">serosa</span> persists but decreases in amount.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>300 g</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>4 Weeks Post-Delivery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Clinically, <span class=\"customMeta\" data-dictid=\"2a4713707c1692777190062b13e806\">involution</span> is complete.</li>\n<li>Lochia <span class=\"customMeta\" data-dictid=\"455facf7ef169277718133da1f91e2\">alba</span> (whitish-yellow discharge).</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>100 g</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>6-8 Weeks Post-Delivery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Uterus returns to normal (pre-pregnant) size.</li>\n<li>Sonographically, <span class=\"customMeta\" data-dictid=\"2a4713707c1692777190062b13e806\">involution</span> is complete at 8 weeks.</li>\n<li>Lochia typically ends.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>60 g</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A primigravida woman at 12 weeks of gestation comes to the antenatal clinic for nutritional advice. Which of the following will you recommend?", "options": [{"label": "A", "text": "Additional 300 kcal in 2nd trimester", "correct": true}, {"label": "B", "text": "Additional 300 kcal throughout the pregnancy", "correct": false}, {"label": "C", "text": "Additional 400 kcal in 3rd trimester", "correct": false}, {"label": "D", "text": "Additional 300 kcal in 1st trimester", "correct": false}], "correct_answer": "A. Additional 300 kcal in 2nd trimester", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:509px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>EAR - Energy (Kcal/D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>RDA - Protein (g/D)</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Man</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sedentary work</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2110</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>54</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Moderate work</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2710</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>54</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Heavy work</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3470</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>54</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Woman</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sedentary work</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1660</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>46</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Moderate work</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2130</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>46</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Heavy work</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2720</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>46</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pregnancy (2nd trimester)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+340</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+9.5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pregnancy (3rd trimester)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+452</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+22</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lactation (0-6 months)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+600</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>530</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lactation (6-12 months)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+520</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>660</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Infant</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>0-6 months</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>530</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>8.0</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6-12 months</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>660</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>10.5</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 56-year-old man presents with dragging pain in the abdomen. On examination, there is a massive splenomegaly. A peripheral smear shows leukocytosis with increased myelocytes, metamyelocytes, and basophils. Which of the following translocations is seen in this condition?", "options": [{"label": "A", "text": "t(9;22)", "correct": true}, {"label": "B", "text": "t(8;21)", "correct": false}, {"label": "C", "text": "t(15;17)", "correct": false}, {"label": "D", "text": "t(8;14)", "correct": false}], "correct_answer": "A. t(9;22)", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/82350LlOl30lvdooyKMJ1746425587.png"], "explanation": "<p>Correct Answer A - t(9;22)</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>CML</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Genetics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Philadelphia <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> (t(9;22))</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Myeloid lineage</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Etiopathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>BCR-ABL <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> gene due to t(9;22) </strong>causes increased tyrosine <span class=\"customMeta\" data-dictid=\"9863da498e1692777190e1c6515b48\">kinase</span> activity.</li>\n<li>Radiation exposure.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Occurs in adults.</li>\n<li>Often presents with splenomegaly, fatigue, weight loss, night sweats, and <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> discomfort.</li>\n<li>It can progress to a <span class=\"customMeta\" data-dictid=\"c961b3ec6516927771831836e7f351\">blast crisis</span> with features of <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> leukemia.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Bone <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">marrow</span> <span class=\"customMeta\" data-dictid=\"a246c8382816927771821a267ea486\">aspirate</span> to confirm diagnosis</li>\n<li>Peripheral smear: shows many <span class=\"customMeta\" data-dictid=\"0472620c171692777192c655af9c57\">mature</span> neutrophils, some metamyelocytes, and myelocytes.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"College girl or garden party appearance CML\" data-author=\"Paulo Henrique Orlandi Mourao\" data-hash=\"11682\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Chronic_Myeloid_Leukemia_smear_2009-04-09.JPG\" data-tags=\"May2025\" src=\"https://image.prepladder.com/notes/82350LlOl30lvdooyKMJ1746425587.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>On FISH - the presence of BCR ABL <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> gene product can be seen.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tyrosine <span class=\"customMeta\" data-dictid=\"9863da498e1692777190e1c6515b48\">kinase</span> inhibitors such as Imatinib.</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old G2P1 woman with 18 weeks of amenorrhea comes with a dilated cervix. The cervical length is 15 mm. In spite of explaining the risks, she insisted on cerclage. Which of the following is a contraindication for cervical cerclage?", "options": [{"label": "A", "text": "Ruptured membranes", "correct": true}, {"label": "B", "text": "Prolapse of membranes into the vagina", "correct": false}, {"label": "C", "text": "Fetal fibronectin positive", "correct": false}, {"label": "D", "text": "Advanced maternal age", "correct": false}], "correct_answer": "A. Ruptured membranes", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A primigravida presents to the emergency room in the early stage of labor with adequate uterine contractions. On per vaginal examination, a gynecoid pelvis is felt, the membranes are ruptured, and the vertex is felt in the right occipito-posterior position. How will you manage this patient?", "options": [{"label": "A", "text": "Vacuum-assisted delivery", "correct": false}, {"label": "B", "text": "Cesarean section", "correct": false}, {"label": "C", "text": "Normal vaginal delivery", "correct": true}, {"label": "D", "text": "Forceps delivery", "correct": false}], "correct_answer": "C. Normal vaginal delivery", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A pregnant patient with a history of a classical cesarean section due to fetal growth retardation in the previous pregnancy presents to you. She is currently at 35 weeks of gestation with breech presentation. What is the next step in management?", "options": [{"label": "A", "text": "Cesarean section at 37 weeks", "correct": true}, {"label": "B", "text": "Advice ultrasound and visit after 2 weeks", "correct": false}, {"label": "C", "text": "Internal podalic version followed by vaginal delivery", "correct": false}, {"label": "D", "text": "External cephalic version at 36 weeks", "correct": false}], "correct_answer": "A. Cesarean section at 37 weeks", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Selection Criteria of Cases for TOLAC (ACOG)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>One (RCOG) or two (ACOG) previous lower segment <span class=\"customMeta\" data-dictid=\"a6260fa86416927772008d36bd7e5f\">transverse</span> scar.</li>\n<li>Nonrecurring indication for prior <span class=\"customMeta\" data-dictid=\"3c6bfcae8c1692777184ceb5d2efc3\">cesarean</span> section.</li>\n<li>Pelvis adequate for the fetus.</li>\n<li>Continued labor monitoring possible.</li>\n<li>Availability of resources (anesthesia, blood <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">transfusion</span> and theatre) for an emergency <span class=\"customMeta\" data-dictid=\"3c6bfcae8c1692777184ceb5d2efc3\">cesarean</span> section within 30 minutes of the decision.</li>\n<li>Informed consent of the woman.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Contraindications for TOLAC (indications for <span class=\"customMeta\" data-dictid=\"3c6bfcae8c1692777184ceb5d2efc3\">Cesarean</span> Delivery)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Previous classical</strong> or inverted T-shaped <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> incision, <span class=\"customMeta\" data-dictid=\"1c9eba730616927771931ce9e67930\">myomectomy</span> scar</li>\n<li>Previously &gt;2 LSCS</li>\n<li>Pelvis contracted or suspected CPD.</li>\n<li>Presence of other complications in pregnancy: Obstetric (pre-eclampsia, malpresentation, <span class=\"customMeta\" data-dictid=\"5276da31d11692777195f0e82f5e1d\">placenta</span> previa) or medical.</li>\n<li>Resources limited for emergency <span class=\"customMeta\" data-dictid=\"3c6bfcae8c1692777184ceb5d2efc3\">cesarean</span> delivery or patient refusal for TOLAC.</li>\n<li>History of prior <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> rupture</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What should be the subsequent course of action in managing a diabetic patient who has a visual acuity of 6/9 in one eye and further investigations reveal preretinal hemorrhages with neovascularization at the optic disc?", "options": [{"label": "A", "text": "Focal laser photocoagulation", "correct": false}, {"label": "B", "text": "Pan-retinal photocoagulation", "correct": true}, {"label": "C", "text": "Grid laser photocoagulation", "correct": false}, {"label": "D", "text": "Scleral buckling", "correct": false}], "correct_answer": "B. Pan-retinal photocoagulation", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/z285dNmpIimqC3EvFgoj1746420083.png"], "explanation": "<p>Correct Answer B - Pan-retinal photocoagulation</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Category </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Management </strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Non-Proliferative <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">Diabetic</span> <span class=\"customMeta\" data-dictid=\"60029fa8cd169277719733357ef47e\">Retinopathy</span> (NPDR):</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>No <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">Diabetic</span> Retinopathy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Review in 12 months</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Very Mild NPDR</strong></p>\n<p>Microaneurysms only</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Review most patients in 12 months</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mild NPDR </strong></p>\n<p>Any or all of the: microaneurysms, <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> hemorrhages, exudates, and <span class=\"customMeta\" data-dictid=\"ef5bc669a416927771854943d1cfa8\">cotton-wool</span> spots, up to the level of moderate NPDR. No <span class=\"customMeta\" data-dictid=\"871f3dc691169277719044c0f27f98\">intraretinal</span> <span class=\"customMeta\" data-dictid=\"910047ee281692777192ceee540959\">microvascular</span> anomalies (IRMA) or significant beading.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Review range 6-12 months, depending on the severity of signs, stability, <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> factors, and patient's circumstances</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Moderate NPDR </strong></p>\n<ul>\n<li>Severe <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> hemorrhages in 1-3 quadrants or mild IRMA</li>\n<li>Significant <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> <span class=\"customMeta\" data-dictid=\"965fde0a5a1692777182ae7e8ede4b\">beading</span> can be present in no more than 1 quadrant</li>\n<li>Cotton <span class=\"customMeta\" data-dictid=\"eaae57387d1692777202060f299953\">wool</span> spots commonly present</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Review in approximately 6 months</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Severe NPDR </strong></p>\n<p>The 4-2-1 rule; is one or more of the:</p>\n<ul>\n<li>Severe hemorrhages in all 4 quadrants</li>\n<li>Significant <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> <span class=\"customMeta\" data-dictid=\"965fde0a5a1692777182ae7e8ede4b\">beading</span> in 2 or more quadrants</li>\n<li>Moderate <span class=\"customMeta\" data-dictid=\"3cf9752a3716927771906966a86682\">IRMA</span> in 1 or more quadrants</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Review in 4 months</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Very severe NPDR </strong></p>\n<p>Two or more of the criteria for severe NPDR</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Review in 2-3 months</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Proliferative <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">Diabetic</span> <span class=\"customMeta\" data-dictid=\"60029fa8cd169277719733357ef47e\">Retinopathy</span> (PDR):</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mild-moderate PDR </strong></p>\n<p>New vessels on the disc (NVD) or new vessels elsewhere (NVE), but extent insufficient to meet the high-risk criteria</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Treatment is considered according to the severity of signs, stability, <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> factors, and the patient's circumstances such as reliability of attendance for review. If not treated,<strong> review in up to 2 months</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>High-risk PDR </strong></p>\n<ul>\n<li>NVD greater than ⅓ disc area</li>\n<li>Any NVD with <span class=\"customMeta\" data-dictid=\"636ccb4336169277720289af6a0778\">vitreous</span> hemorrhage</li>\n<li>NVE greater than ½ disc area with <span class=\"customMeta\" data-dictid=\"636ccb4336169277720289af6a0778\">vitreous</span> hemorrhage</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Treatment should be performed <strong>immediately</strong> when possible and certainly on the same day if <span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\">symptomatic</span> presentation with a good <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> view</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Advanced <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">diabetic</span> eye disease</strong></p>\n<p>Is characterized by tractional <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> detachment. Significant persistent <span class=\"customMeta\" data-dictid=\"636ccb4336169277720289af6a0778\">vitreous</span> <span class=\"customMeta\" data-dictid=\"4642acfc0c16927771880b34fa5174\">hemorrhage</span> and <span class=\"customMeta\" data-dictid=\"624c00049d1692777193b1a9d81379\">neovascular</span> glaucoma.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Vitreoretinal surgery with photocoagulation</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An 11-year-old child with a history of streptococcal pharyngitis presents with fever and arthralgia. There is no past history of rheumatic heart disease or carditis. How often is 600,000 IU of benzathine penicillin recommended for prophylaxis of rheumatic heart disease?", "options": [{"label": "A", "text": "Immediately", "correct": false}, {"label": "B", "text": "Thrice weekly lifelong", "correct": false}, {"label": "C", "text": "Once in three weeks for 5 years or till the age of 18, whichever is longer", "correct": true}, {"label": "D", "text": "Once in three weeks for 10 years or till the age of 25, whichever is longer", "correct": false}], "correct_answer": "C. Once in three weeks for 5 years or till the age of 18, whichever is longer", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:625px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Recommended Duration</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Without Carditis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>5 years after the last attack or until 18 years of age, whichever is longer</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>With <span class=\"customMeta\" data-dictid=\"7b028d193416927771835d48b193f9\">Carditis</span> but No <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">Residual</span> Valvular Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>10 years or until 21–25 years of age, whichever is longer</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>With Persistent Valvular Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>At least 10 years or until 40 years of age; lifelong <span class=\"customMeta\" data-dictid=\"bc36e9b9381692777196b5f9a2f79c\">prophylaxis</span> may be required</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Low-risk Populations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Moderate- and High-risk Populations</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Major Criteria</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Carditis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clinical or subclinical</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clinical or subclinical</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Arthritis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Polyarthritis only</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Polyarthritis, polyarthralgia, or monoarthritis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Chorea</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Yes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Yes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Erythema Marginatum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Yes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Yes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Subcutaneous Nodules</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Yes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Yes</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Minor Criteria</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Carditis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clinical or subclinical</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clinical or subclinical</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Arthritis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Polyarthritis only</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Polyarthritis, polyarthralgia, or monoarthritis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Polyarthralgia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Not applicable</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Yes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fever</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>≥38.5°C</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>≥38.0°C</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>ESR</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>≥60 mm in the first hour</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>≥30 mm/hr and/or <span class=\"customMeta\" data-dictid=\"4df81a22571692777185a288d3c63d\">CRP</span> ≥3.0 mg/dL</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prolonged PR Interval</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Yes, after age variability</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Yes, after age variability</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Monoarthralgia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Not applicable</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Yes</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>For All Patient Populations</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Evidence of Preceding Group A Streptococcal Infection</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increased ASLO/anti-DNAse B <span class=\"customMeta\" data-dictid=\"07e6f3a1921692777200051f692a60\">titer</span> or positive throat culture or positive rapid strep test</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis of Initial ARF</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2 Major criteria or 1 Major + 2 Minor criteria</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis of <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">Recurrent</span> ARF</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2 Major criteria or 1 Major + 2 Minor or 3 Minor criteria</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A man on diuretics presents with weakness. An ECG shows flat T waves and prominent U waves. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Hypocalcemia", "correct": false}, {"label": "B", "text": "Hypomagnesemia", "correct": false}, {"label": "C", "text": "Hyperkalemia", "correct": false}, {"label": "D", "text": "Hypokalemia", "correct": true}], "correct_answer": "D. Hypokalemia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/xVRDRGvQoevDLAxkXQpy1745400407.png", "https://image.prepladder.com/notes/gd3JhKLHcwaLjzecjKMz1746271581.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A primigravida at 22 weeks of gestation presents with profuse vaginal bleeding. Her blood pressure and glucose levels are within normal limits. Placental implantation at which of the following sites can cause this?", "options": [{"label": "A", "text": "Internal os", "correct": true}, {"label": "B", "text": "Fallopian tube", "correct": false}, {"label": "C", "text": "Ovarian", "correct": false}, {"label": "D", "text": "Abdominal", "correct": false}], "correct_answer": "A. Internal os", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/2Di9mWmXWb4vINeGjUjX1745400418.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:654px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Definitions</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Low lying</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"5276da31d11692777195f0e82f5e1d\">placenta</span> is implanted in the lower <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> segment but does not reach the internal os.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Marginal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The edge of the <span class=\"customMeta\" data-dictid=\"5276da31d11692777195f0e82f5e1d\">placenta</span> is at the margin of the internal os.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Incomplete/ partial central</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"5276da31d11692777195f0e82f5e1d\">placenta</span> partially covers the internal os of the cervix.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Central/complete</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"5276da31d11692777195f0e82f5e1d\">placenta</span> completely covers the internal os of the cervix.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:606px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Definitions </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>True <span class=\"customMeta\" data-dictid=\"5276da31d11692777195f0e82f5e1d\">Placenta</span> previa</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"5276da31d11692777195f0e82f5e1d\">placenta</span> covers the internal os</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Low lying placenta</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"5276da31d11692777195f0e82f5e1d\">placenta</span> lies within 2cm of internal is but does not cover it</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A male patient presents to the emergency department with the following arterial blood gas (ABG) values: pH: 7.2 pCO2: 81 mmHg HCO3: 40 mEq/L What is the most likely diagnosis?", "options": [{"label": "A", "text": "Respiratory alkalosis", "correct": false}, {"label": "B", "text": "Metabolic acidosis", "correct": false}, {"label": "C", "text": "Respiratory acidosis", "correct": true}, {"label": "D", "text": "Metabolic alkalosis", "correct": false}], "correct_answer": "C. Respiratory acidosis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:729px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Parameter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Metabolic Acidosis</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Metabolic Alkalosis</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Respiratory Acidosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Respiratory Alkalosis</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Primary Disturbance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓ HCO₃⁻ (Bicarbonate)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑ HCO₃⁻ (Bicarbonate)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑ PaCO₂ (Hypoventilation)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓ PaCO₂ (Hyperventilation)</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"5\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>ABG Parameters</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>pH</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓ (Acidemia)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑ (Alkalemia)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓ (Acidemia)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑ (Alkalemia)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>HCO₃⁻ (Bicarbonate)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal or ↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal or ↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>PaCO₂ (Carbon dioxide)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal or ↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal or ↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Compensation Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Respiratory: </strong>Hyperventilation (↓ PaCO₂)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Respiratory: </strong>Hypoventilation (↑ PaCO₂)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Renal: </strong>↑ HCO₃⁻ reabsorption, ↑ H⁺ excretion</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Renal: </strong>↓ HCO₃⁻ reabsorption, ↓ H⁺ excretion</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"5\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Compensation Status</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Compensated</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal pH, ↓ HCO₃⁻, ↓ PaCO₂</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal pH, ↑ HCO₃⁻, ↑ PaCO₂</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal pH, ↑ PaCO₂, ↑ HCO₃⁻</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal pH, ↓ PaCO₂, ↓ HCO₃⁻</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Decompensated</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓ pH, ↓ HCO₃⁻, inadequate ↓ PaCO₂</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑ pH, ↑ HCO₃⁻, inadequate ↑ PaCO₂</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓ pH, ↑ PaCO₂, inadequate ↑ HCO₃⁻</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑ pH, ↓ PaCO₂, inadequate ↓ HCO₃⁻</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>↑ <span class=\"customMeta\" data-dictid=\"53e82fca731692777181e629a02799\">Anion</span> Gap:</strong></p>\n<ul>\n<li>DKA, <span class=\"customMeta\" data-dictid=\"b82539c9ae1692777191a3f7ddd7bb\">Lactic</span> acidosis</li>\n</ul>\n<p> </p>\n<p><strong>Normal <span class=\"customMeta\" data-dictid=\"53e82fca731692777181e629a02799\">Anion</span> Gap:</strong></p>\n<ul>\n<li>Diarrhea, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">Tubular</span> <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">Acidosis</span> (RTA)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Vomiting</li>\n<li>Diuretics</li>\n<li>Antacid overuse</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>COPD</li>\n<li>Respiratory depression</li>\n<li>Airway obstruction</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Anxiety</li>\n<li>Pain</li>\n<li>Fever</li>\n<li>High altitude</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Kussmaul breathing</li>\n<li>Confusion</li>\n<li>Hypotension</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Muscle cramps</li>\n<li>Tetany</li>\n<li>Hypokalemia</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Headache</li>\n<li>Confusion</li>\n<li>Dyspnea</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Dizziness</li>\n<li>Numbness</li>\n<li>Tetany</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not seen in MEN 2B syndrome?", "options": [{"label": "A", "text": "Megacolon", "correct": false}, {"label": "B", "text": "Parathyroid adenoma", "correct": true}, {"label": "C", "text": "Mucosal neuroma", "correct": false}, {"label": "D", "text": "Marfanoid habitus", "correct": false}], "correct_answer": "B. Parathyroid adenoma", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:718px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>MEN 1 (Wermer Syndrome)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>MEN 2A (Sipple Syndrome)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>MEN 2B (MEN 3)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>MEN 4</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gene: MEN1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gene: RET</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gene: RET</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gene: CDKN1B</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pituitary Adenomas</li>\n<li>Pancreatic <span class=\"customMeta\" data-dictid=\"7eca2476201692777193e0a0959bd7\">Neuroendocrine</span> Tumors</li>\n<li>Primary Hyperparathyroidism</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Medullary <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">Thyroid</span> Carcinoma</li>\n<li>Phaeochromocytoma</li>\n<li>Primary Hyperparathyroidism</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Medullary <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">Thyroid</span> Carcinoma</li>\n<li>Phaeochromocytoma</li>\n<li>Mucosal Neuromas</li>\n<li>Marfanoid Habitus</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pituitary Adenomas</li>\n<li>Pancreatic <span class=\"customMeta\" data-dictid=\"7eca2476201692777193e0a0959bd7\">Neuroendocrine</span> Tumors</li>\n<li>Primary Hyperparathyroidism</li>\n<li>Reproductive Tumors</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with coronary artery disease presents to you with chest pain and palpitations. The ECG is shown below. Which of the following can be used in the management?", "options": [{"label": "A", "text": "Oral metoprolol", "correct": false}, {"label": "B", "text": "Oral amiodarone", "correct": false}, {"label": "C", "text": "Intravenous amiodarone", "correct": true}, {"label": "D", "text": "Intravenous metoprolol", "correct": false}], "correct_answer": "C. Intravenous amiodarone", "question_images": ["https://image.prepladder.com/content/60LrMdVfVR3x4Wswyu8C1745400645.png"], "explanation_images": ["https://image.prepladder.com/content/ujApyW9nWnkRHNc4Dv671745400700.png", "https://image.prepladder.com/content/2COaguDA3rVr1iKZdqCw1745400703.png", "https://image.prepladder.com/content/qzeBjfQEXj2aBK8CvVvD1745400707.png", "https://image.prepladder.com/content/Dhq7ViQ6wcSzILRCyU5f1745400710.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Shockable Conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Non-Shockable Conditions</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ventricular Fibrillation</strong></p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"110\" src=\"https://image.prepladder.com/content/ujApyW9nWnkRHNc4Dv671745400700.png\" width=\"466\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Asystole</strong></p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"144\" src=\"https://image.prepladder.com/content/2COaguDA3rVr1iKZdqCw1745400703.png\" width=\"466\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ventricular <span class=\"customMeta\" data-dictid=\"af1cd978a41692777200da2f67bf22\">Tachycardia</span> </strong></p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"240\" src=\"https://image.prepladder.com/content/qzeBjfQEXj2aBK8CvVvD1745400707.png\" width=\"466\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pulseless Electrical Activity</strong></p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"133\" src=\"https://image.prepladder.com/content/Dhq7ViQ6wcSzILRCyU5f1745400710.png\" width=\"466\"/></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:640px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Shockable Conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Non-Shockable Conditions</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Immediate Recognition</strong></p>\n<p style=\"text-align:center\"><strong>Identify Shockable Rhythm:</strong> Recognize VF or <span class=\"customMeta\" data-dictid=\"b38826787e16927771969ff8eb6e09\">pulseless</span> VT.</p>\n<p style=\"text-align:center\"><strong>Activate Emergency Response: </strong>Call for advanced life support.</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\"><strong>Initiate CPR</strong></p>\n<p style=\"text-align:center\"><strong>Start High-Quality CPR: </strong>Perform chest compressions at a rate of 100-120/min, with a depth of 5-6 cm. Continue CPR for 2 minutes.</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\"><strong>Defibrillation</strong></p>\n<p style=\"text-align:center\">After 2 minutes of CPR, deliver a Non-Synchronized DC Shock to restore normal rhythm.</p>\n<p style=\"text-align:center\">If no change, administer a second shock immediately.</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\"><strong>Continue CPR</strong></p>\n<p style=\"text-align:center\">Resume CPR for 2 Minutes</p>\n<p style=\"text-align:center\">Place an <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> or <span class=\"customMeta\" data-dictid=\"6a346f84561692777190430904e7b3\">intraosseous</span> line for drug administration.</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\"><strong>Administer Epinephrine</strong></p>\n<p style=\"text-align:center\">Epinephrine 1 mg (1:10,000): Given IV/IO after 2 minutes of CPR to enhance <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> <span class=\"customMeta\" data-dictid=\"33dfead74b1692777195931780bd9e\">perfusion</span> pressure.</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\"><strong>Advanced <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">Airway</span> Management</strong></p>\n<p style=\"text-align:center\"><strong>Secure Airway: </strong>Perform <span class=\"customMeta\" data-dictid=\"cdccef317a1692777187a7bc217232\">endotracheal</span> <span class=\"customMeta\" data-dictid=\"83e66fab2f1692777190a43a6e300f\">intubation</span> if necessary.</p>\n<p style=\"text-align:center\"><strong>Capnography:</strong> Monitor <span class=\"customMeta\" data-dictid=\"959389429f1692777187a5fa1e94a9\">end-tidal</span> CO2 levels.</p>\n<p style=\"text-align:center\"><strong>Ventilation:</strong> Provide 1 breath every 6 seconds post-intubation.</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\"><strong>Further Defibrillation</strong></p>\n<p style=\"text-align:center\"><strong>Third Shock:</strong> If VF or <span class=\"customMeta\" data-dictid=\"b38826787e16927771969ff8eb6e09\">pulseless</span> VT persists, deliver a third non-synchronized shock.</p>\n<p style=\"text-align:center\">Continue CPR for 2 More Minutes: Follow with additional CPR.</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\"><strong>Administer <span class=\"customMeta\" data-dictid=\"2f4652078816927771814621857a81\">Antiarrhythmic</span> Medication</strong></p>\n<p style=\"text-align:center\"><strong>Amiodarone 300 mg IV: </strong>Administer for shock-refractory VT to stabilize heart rhythm.</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\"><strong>Identify and Treat <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">Reversible</span> Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Immediate Recognition</strong></p>\n<p style=\"text-align:center\"><strong>Identify Non-Shockable Rhythm:</strong> Recognize <span class=\"customMeta\" data-dictid=\"91769de9d4169277718220e09c463f\">asystole</span> or <span class=\"customMeta\" data-dictid=\"b38826787e16927771969ff8eb6e09\">pulseless</span> <span class=\"customMeta\" data-dictid=\"c34137b40a1692777187edcef44647\">electrical activity</span> (PEA).</p>\n<p style=\"text-align:center\"><strong>Activate Emergency Response:</strong> Call for advanced life support.</p>\n<p style=\"text-align:center\">↓<br/>\n<strong>Initiate CPR</strong></p>\n<p style=\"text-align:center\"><strong>Start High-Quality CPR: </strong>Perform chest compressions at a rate of 100-120/min, with a depth of 5-6 cm. Continue CPR for 2 minutes.</p>\n<p style=\"text-align:center\">↓<br/>\n<strong>Establish <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> or <span class=\"customMeta\" data-dictid=\"6a346f84561692777190430904e7b3\">intraosseous</span> line for medication administration.</strong></p>\n<p style=\"text-align:center\">↓<br/>\n<strong>Administer Epinephrine</strong></p>\n<p style=\"text-align:center\"><strong>Epinephrine 1 mg (1:10,000):</strong> Administer IV/IO after the first 2 minutes of CPR.</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\"><strong>Identify Rhythm</strong></p>\n<ul>\n<li style=\"text-align:center\"><strong>Non-Shockable Rhythm: </strong>Continue CPR and administer <span class=\"customMeta\" data-dictid=\"76baf6616a169277718738f8790ab9\">epinephrine</span> every 3-5 minutes.</li>\n</ul>\n<p style=\"text-align:center\"><strong>Goal: To increase the likelihood of developing a shockable rhythm, such as <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> <span class=\"customMeta\" data-dictid=\"6ae0ac06031692777202699c4c75a0\">fibrillation</span> (VF), which is necessary for effective defibrillation.</strong></p>\n<ul>\n<li style=\"text-align:center\"><strong>Shockable Rhythm:</strong> Administer a Non-Synchronized DC Shock to restore normal rhythm.</li>\n</ul>\n<p style=\"text-align:center\">↓<br/>\n<strong>Advanced <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">Airway</span> Management</strong></p>\n<p style=\"text-align:center\"><strong>Airway: </strong>Secure the <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> with <span class=\"customMeta\" data-dictid=\"cdccef317a1692777187a7bc217232\">endotracheal</span> <span class=\"customMeta\" data-dictid=\"83e66fab2f1692777190a43a6e300f\">intubation</span> if necessary.</p>\n<p style=\"text-align:center\"><strong>Capnography: </strong>Monitor <span class=\"customMeta\" data-dictid=\"959389429f1692777187a5fa1e94a9\">end-tidal</span> CO2 levels.</p>\n<p style=\"text-align:center\"><strong>Ventilation: </strong>Provide 1 breath every 6 seconds post-intubation for adequate oxygenation.</p>\n<p style=\"text-align:center\">↓<br/>\n<strong>Continue CPR</strong></p>\n<p style=\"text-align:center\">Resume chest compressions for 2 minutes.</p>\n<p style=\"text-align:center\">↓<br/>\n<strong>Identify and Treat <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">Reversible</span> Causes</strong></p>\n<p style=\"text-align:center\"><strong>Primary Focus:</strong> Address <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">reversible</span> causes, especially hypothermia.</p>\n<p style=\"text-align:center\">↓<br/>\n<strong>Repeat CPR and Epinephrine</strong></p>\n<p style=\"text-align:center\"><strong>Cycle: </strong>Continue repeating CPR and <span class=\"customMeta\" data-dictid=\"76baf6616a169277718738f8790ab9\">epinephrine</span> administration every 3-5 minutes.</p>\n<p style=\"text-align:center\"> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female patient presents with six weeks of amenorrhea, associated with abdominal pain and vaginal bleeding. Her blood pressure is normal. Investigations reveal beta-hCG of 1400 mIU/mL. An ultrasound shows a trilaminar endometrium with normal adnexa. What is the next best step in management?", "options": [{"label": "A", "text": "Repeat beta-hCG after 48 hours", "correct": true}, {"label": "B", "text": "Repeat ultrasound after 3 days", "correct": false}, {"label": "C", "text": "Measurement of progesterone", "correct": false}, {"label": "D", "text": "Laparoscopy", "correct": false}], "correct_answer": "A. Repeat beta-hCG after 48 hours", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:562px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Serial beta-hCG Measurement</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Normal <span class=\"customMeta\" data-dictid=\"1d5d2712dc169277719050154d38a1\">Intrauterine</span> Pregnancy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rising beta-hCG (doubling every 1.4–2 days)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ectopic Pregnancy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Plateauing or declining beta-hCG</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Threatened Abortion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Variable beta-hCG changes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Early Pregnancy Loss</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Declining beta-hCG</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Multidrug-resistant (MDR) tuberculosis shows resistance to which of the following drugs?", "options": [{"label": "A", "text": "Isoniazid, rifampicin, and fluoroquinolone", "correct": false}, {"label": "B", "text": "Fluoroquinolones", "correct": false}, {"label": "C", "text": "Isoniazid and rifampicin", "correct": true}, {"label": "D", "text": "Isoniazid, rifampicin, and kanamycin", "correct": false}], "correct_answer": "C. Isoniazid and rifampicin", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:613px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Drug-Sensitive <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">Tuberculosis</span> (DSTB)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Tuberculosis that is <span class=\"customMeta\" data-dictid=\"55691242bb1692777199360f64cb67\">susceptible</span> to the first-line anti-TB drugs, such as <span class=\"customMeta\" data-dictid=\"5d8c24b3cb16927771909a5195d7f8\">isoniazid</span> and rifampin.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Drug-Resistant <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">Tuberculosis</span> (DR-TB)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>TB caused by <span class=\"customMeta\" data-dictid=\"e99dbef99f169277719344843cf75a\">Mycobacterium</span> <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> strains that are resistant to at least one first-line anti-TB drug.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Multidrug-Resistant <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">Tuberculosis</span> (MDR-TB)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>TB caused by <span class=\"customMeta\" data-dictid=\"e99dbef99f169277719344843cf75a\">Mycobacterium</span> <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> strains that are resistant to at least <span class=\"customMeta\" data-dictid=\"5d8c24b3cb16927771909a5195d7f8\">isoniazid</span> and rifampin, the two most potent first-line anti-TB drugs.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Extensively <span class=\"customMeta\" data-dictid=\"d4c88fcae71692777186aa1c32423a\">Drug-Resistant</span> <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">Tuberculosis</span> (XDR-TB)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A more severe <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> of MDR-TB resistant to isoniazid, rifampin, fluoroquinolones, and at least one of the second-line <span class=\"customMeta\" data-dictid=\"c3d7276c3e1692777190b4b6762dd0\">injectable</span> drugs (e.g., amikacin, kanamycin, or capreomycin).</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with fever, jaundice, and malaise. Based on the serology reports provided, what is the most likely diagnosis? Serology Reports: HBsAg: Positive Anti-HBc: Positive Anti-HCV: Negative", "options": [{"label": "A", "text": "Acute hepatitis D", "correct": false}, {"label": "B", "text": "Acute hepatitis B", "correct": true}, {"label": "C", "text": "Chronic hepatitis B", "correct": false}, {"label": "D", "text": "Chronic hepatitis C", "correct": false}], "correct_answer": "B. Acute hepatitis B", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/K3f7W4uc3TdxyUN2lxqb1745400916.png", "https://image.prepladder.com/content/6CHkHgQYkYof67mML47N1745400924.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:766px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical Phases</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>HBsAg</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Anti-HBs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>HBeAg</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Anti-HBe</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Anti-HBc</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>HBV DNA</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Acute HBV - Early-phase, high infectivity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>IgM</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+++</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>IgM</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Acute HBV - Window phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>IgM</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Acute HBV - Recovery phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>IgG</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Chronic HBV, high infectivity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>IgG</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Chronic HBV, low infectivity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>IgG</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+/-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>HBV infection in the recent past</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+/-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>IgG</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+/-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>HBV infection in the remote past</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+/-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+/-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>IgG</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>+</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Post-vaccination</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>IgG</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>-</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the image, what are the associated complications observed in a 35-year-old woman who has been diagnosed with rheumatoid arthritis?", "options": [{"label": "A", "text": "Scleromalacia perforans", "correct": true}, {"label": "B", "text": "Ciliary staphyloma", "correct": false}, {"label": "C", "text": "Coloboma", "correct": false}, {"label": "D", "text": "Malignant melanoma", "correct": false}], "correct_answer": "A. Scleromalacia perforans", "question_images": ["https://image.prepladder.com/notes/ps6HupvojJqLYkFdh9CW1746420161.png"], "explanation_images": ["https://image.prepladder.com/notes/ps6HupvojJqLYkFdh9CW1746420161.png"], "explanation": "<p>Correct Answer A - &lt;span class=\"customMeta\" data-dictid=\"516238f054169277719881ad620559\"&gt;Scleromalacia&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the diagnosis?", "options": [{"label": "A", "text": "Intraocular foreign body", "correct": false}, {"label": "B", "text": "Pseudoexfoliation syndrome", "correct": true}, {"label": "C", "text": "Ocular trauma", "correct": false}, {"label": "D", "text": "Vossius ring", "correct": false}], "correct_answer": "B. Pseudoexfoliation syndrome", "question_images": ["https://image.prepladder.com/notes/CBYTpt4Etglxqi9HwF2e1746420299.png"], "explanation_images": [], "explanation": "<p>Correct Answer B - &lt;span class=\"customMeta\" data-dictid=\"8bf85a91251692777196c77aaaaf40\"&gt;Pseudoexfoliation&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 24-year-old lactating female with an 18-month-old child presents with a history of irregular, heavy bleeding and seeks contraceptive advice. Which contraceptive is the most appropriate choice for her?", "options": [{"label": "A", "text": "Progestasert", "correct": false}, {"label": "B", "text": "Copper-T 380A", "correct": false}, {"label": "C", "text": "Mala N", "correct": true}, {"label": "D", "text": "Norethisterone enanthate - depot injection", "correct": false}], "correct_answer": "C. Mala N", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/oGVERcqhVxme8RftUBYW1745400839.png"], "explanation": "\n<p><strong>References:</strong></p>\n<ul><li>↳ Williams Obstetrics, 25th Edition, Page: 682</li><li>↳ Williams Gynecology, 3rd Edition, Page: 106-108</li><li>↳ Ghai Essential Pediatrics, 9th Edition, Page 6</li><li>↳ https://nhm.gov.in/images/pdf/programmes/family-planing/guidelines/Reference_Manual_Oral_Pills.pdf</li></u\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What will be observed in a patient diagnosed with sympathetic ophthalmitis, and a history of penetrating eye injury?", "options": [{"label": "A", "text": "Acute anterior uveitis", "correct": false}, {"label": "B", "text": "Pars planitis", "correct": false}, {"label": "C", "text": "Panuveitis", "correct": true}, {"label": "D", "text": "Chronic anterior uveitis", "correct": false}], "correct_answer": "C. Panuveitis", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/sBuh9HPFc0YhACSHQerI1746420439.png", "https://image.prepladder.com/notes/M0lJxEwsOurDR5PYqRKE1746420517.png"], "explanation": "<p>Correct Answer C - Panuveitis</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Sympathetic <span class=\"customMeta\" data-dictid=\"722c35f97c169277719457b4886144\">ophthalmitis</span> (SO)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Bilateral, granulomatous, panuveitis</strong> occurring after <span class=\"customMeta\" data-dictid=\"55b31d659b16927771958a15837b10\">penetrating</span> trauma where <strong>uveal prolapse</strong> may have been a feature of the trauma</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Etiology and pathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Trauma to one eye <strong>(exciting eye) </strong>— 2 weeks to 3 months — <span class=\"customMeta\" data-dictid=\"b07d6fd6ef1692777201015472cd79\">Uveitis</span> in the uninjured eye <strong>(sympathizing eye).</strong></li>\n<li><strong>T-cell mediated <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">autoimmune</span> <span class=\"customMeta\" data-dictid=\"2c7e1ce33316927771892ce1da8276\">hypersensitivity</span> reaction to <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">Retinal</span> S antigen. </strong></li>\n<li>Maximum risk upon injury to the <span class=\"customMeta\" data-dictid=\"1be9f55b2d1692777184b9d813b17e\">ciliary</span> body.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histopathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Diffuse lymphocytic <span class=\"customMeta\" data-dictid=\"669bdcb3111692777190e018ae930e\">infiltration</span> of the choroid.</li>\n<li>Scattered aggregates of <span class=\"customMeta\" data-dictid=\"ed5f81953d1692777187529a6de318\">epithelioid</span> cells are seen, many of which contain fine granules of melanin.</li>\n<li>Dalen–Fuchs nodules - granulomas located between Bruch <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> and the <span class=\"customMeta\" data-dictid=\"142f8e4f971692777197f051738400\">RPE</span> (also seen in VKH syndrome)</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\" Dalen Fuchs nodules\" data-author=\"Xi K Chu,Chi-Chao Chan\" data-hash=\"11653\" data-license=\"CC BY 2.0\" data-source=\"https://www.researchgate.net/figure/Montage-fundus-photograph-of-a-sympathetic-ophthalmia-retina-Yellow-white-subretinal_fig1_237001131\" data-tags=\"May2025\" height=\"349\" src=\"https://image.prepladder.com/notes/sBuh9HPFc0YhACSHQerI1746420439.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"da55d37dc51692777187ee41eeebc5\">exciting eye</span> is frequently red and irritable.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"659d09e49516927771995a19c72a5f\">sympathizing eye</span> develops irritation, blurred vision, <span class=\"customMeta\" data-dictid=\"46e2a1c298169277719583f46ff587\">photophobia</span> and loss of <span class=\"customMeta\" data-dictid=\"c0682eacfc1692777180ad2c556c19\">accommodation</span> causing difficulty in near vision <strong>(first symptom)</strong></li>\n<li>Anterior <span class=\"customMeta\" data-dictid=\"b07d6fd6ef1692777201015472cd79\">uveitis</span> develops in both eyes, which may be mild or severe and is usually granulomatous</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Investigations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Fundus exam: </strong>Dalen–Fuchs nodules, Exudative <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> detachment, <span class=\"customMeta\" data-dictid=\"fcb3e0d7911692777201ffb9695dea\">vasculitis</span> and <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> disc swelling.</li>\n<li>As <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> settles, <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">residual</span> <span class=\"customMeta\" data-dictid=\"3e48c7feaa169277718485430831dd\">chorioretinal</span> <span class=\"customMeta\" data-dictid=\"e9dcc3d4241692777198c7030bf313\">scarring</span> may confer a <strong>‘sunset glow’ appearance</strong> similar to VKH.</li>\n<li><strong>B-scan ultrasonography</strong>: Choroidal thickening and <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> detachment</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Enucleation of a severely injured eye</strong> within 10 to 14 days of the injury is effective in preventing or reducing the severity of SO</li>\n<li><strong>Steroids</strong> are the basis of initial treatment. <strong>Intravenous</strong> <span class=\"customMeta\" data-dictid=\"c3adf9f403169277719294351e8fb8\">methylprednisolone</span> followed by high-dose <strong>oral</strong> <span class=\"customMeta\" data-dictid=\"2d5e8899351692777196bdf7ced01d\">prednisolone</span> is given for several months and gradually tapered according to response. Supplementary <strong>topical</strong> steroids and cycloplegics may be given</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old male patient is evaluated for primary infertility. Semen analysis shows azoospermia. A testicular biopsy is done, and the image is shown below. The shown finding is consistent with which of the following:", "options": [{"label": "A", "text": "Sertoli cell only syndrome", "correct": true}, {"label": "B", "text": "Testicular atrophy", "correct": false}, {"label": "C", "text": "Benign testicular neoplasm", "correct": false}, {"label": "D", "text": "Orchitis", "correct": false}], "correct_answer": "A. Sertoli cell only syndrome", "question_images": ["https://image.prepladder.com/notes/vhhyG3VjHnTixESB91GF1746423901.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 20-year-old woman presents at 7 weeks of gestation, unwilling to continue the pregnancy. Which drugs are used for medical termination of pregnancy in this patient?", "options": [{"label": "A", "text": "Misoprostol and Medroxyprogesterone", "correct": false}, {"label": "B", "text": "Misoprostol and Mifepristone", "correct": true}, {"label": "C", "text": "Mifepristone and Methotrexate", "correct": false}, {"label": "D", "text": "Mifepristone and Medroxyprogesterone", "correct": false}], "correct_answer": "B. Misoprostol and Mifepristone", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Gestational Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Abortive method</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Up to 7 weeks</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Medical Abortion </strong>(99% success rate if done before 7 weeks)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Up to 9 weeks</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Up to 10 weeks</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Medical Abortion</li>\n<li>Suction evacuation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Up to 12 weeks</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Suction evacuation</li>\n<li>Dilatation and <span class=\"customMeta\" data-dictid=\"f857ee35331692777185a5895e53b5\">Curettage</span> (D&amp;C)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>12-20 weeks </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dilatation and <span class=\"customMeta\" data-dictid=\"0705e4cf081692777187f4d2b512aa\">Evacuation</span> (D&amp;E)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>20-24 weeks </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Dilatation and <span class=\"customMeta\" data-dictid=\"0705e4cf081692777187f4d2b512aa\">Evacuation</span> (D&amp;E)</li>\n<li>Prostaglandin Induction.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>&gt;24 weeks</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hysterotomy</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What does this image indicate?", "options": [{"label": "A", "text": "Keratoconus", "correct": true}, {"label": "B", "text": "Vogt's limbal girdle", "correct": false}, {"label": "C", "text": "Keratoglobus", "correct": false}, {"label": "D", "text": "Corneal dystrophy", "correct": false}], "correct_answer": "A. Keratoconus", "question_images": ["https://image.prepladder.com/notes/oAKphHEvfODJQbHOvE5m1746422384.png"], "explanation_images": ["https://image.prepladder.com/notes/jadYECuckTrqtd53Y5u11746422453.png", "https://image.prepladder.com/notes/oAKphHEvfODJQbHOvE5m1746422384.png", "https://image.prepladder.com/notes/1eljDyAZg7QwSdkF89lP1746422578.png"], "explanation": "<p>Correct Answer A - Keratoconu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the image modality given below.", "options": [{"label": "A", "text": "Cerebral blood flow scan", "correct": false}, {"label": "B", "text": "Sestamibi scan", "correct": false}, {"label": "C", "text": "PET CT", "correct": true}, {"label": "D", "text": "Full body MDCT", "correct": false}], "correct_answer": "C. PET CT", "question_images": ["https://image.prepladder.com/notes/b7K6mGusUPsqyaylfOfw1746427325.png"], "explanation_images": ["https://image.prepladder.com/content/7bSXco6iAdbeIDzqQG4L1745402646.png", "https://image.prepladder.com/content/Z5MgPTCD2nx1SlzZ9btl1745402651.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:622px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>PET</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>SPECT (Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Cost</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Very expensive</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Less expensive</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Radioactive Tracers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Uses positron-emitting <span class=\"customMeta\" data-dictid=\"4dd949a23a1692777197a5627fa8d8\">radioisotope</span> (tracer): F-18 <span class=\"customMeta\" data-dictid=\"ec5e1adbe91692777202365bd7bbc8\">fluorodeoxyglucose</span> (FDG)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Uses gamma-emitting radioisotopes (tracers): technetium-99m, iodine-123, iodine-131</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Detector Design</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Ring of multiple detectors</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Usually one large crystal-based detector</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Image Quality</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Better contrast and <span class=\"customMeta\" data-dictid=\"6495ef882b169277719896942b51c3\">spatial</span> resolution</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Poor contrast and <span class=\"customMeta\" data-dictid=\"6495ef882b169277719896942b51c3\">spatial</span> resolution</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Functionality</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Shows <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> changes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Doesn't show <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> changes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Sensitivity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>More sensitive</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Less sensitive; fewer events detected.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Imaging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Jens Maus\" data-hash=\"\" data-license=\"OPEN ACCESS\" data-source=\"https://en.wikipedia.org/wiki/Positron_emission_tomography#/media/File:PET-image.jpg\" data-tags=\"\" height=\"400\" src=\"https://image.prepladder.com/content/7bSXco6iAdbeIDzqQG4L1745402646.png\" width=\"464\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Bruno Di Muzio\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/normal-brain-perfusion-spect#image-7643964\" data-tags=\"\" height=\"281\" src=\"https://image.prepladder.com/content/Z5MgPTCD2nx1SlzZ9btl1745402651.png\" width=\"345\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "After a road traffic accident, a patient arrives at the emergency department. Upon examination, the patient is awake and alert, with a blood pressure of 90/60 mm Hg, a respiratory rate of 40 breaths per minute, and a pulse rate of 120 bpm. An X-ray is provided for evaluation. What would be the subsequent course of action in terms of treatment?", "options": [{"label": "A", "text": "Chest tube insertion", "correct": true}, {"label": "B", "text": "Pericardiocentesis", "correct": false}, {"label": "C", "text": "Thoracotomy", "correct": false}, {"label": "D", "text": "Pleurodesis", "correct": false}], "correct_answer": "A. Chest tube insertion", "question_images": ["https://image.prepladder.com/notes/zafiQQA15NbEmMedm2XA1746428011.png"], "explanation_images": ["https://image.prepladder.com/content/9XggBOCJADMwnUPWIRvq1745402772.png", "https://image.prepladder.com/content/lZGOvln1y0Grkp57vuX11745402775.png", "https://image.prepladder.com/content/5Ph4FJGyhJ6S9UJgvAlC1745402801.png", "https://image.prepladder.com/content/3O4NAj6L73A1IT7CM64z1745402807.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:560px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Parameter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Normal Lung</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Pneumothorax Lung</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Inspiration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Black</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Black</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Expiration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>White</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Black</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Tension <span class=\"customMeta\" data-dictid=\"d9d1e6f2801692777196f37b28fb6a\">pneumothorax</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Loculated <span class=\"customMeta\" data-dictid=\"d9d1e6f2801692777196f37b28fb6a\">pneumothorax</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Significant <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> <span class=\"customMeta\" data-dictid=\"fa328dbc09169277718631e23a772f\">deviation</span> of the mediastinum</li>\n<li>Collapsed lung</li>\n<li>Depression of <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> hemidiaphragm</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Finlayson, Gordon N., Albert Chiang, Jay B Brodsky and Walter Bradford Cannon. “Intraoperative contralateral tension pneumothorax during pneumonectomy.” Anesthesia and analgesia 106 1 (2008): 58-60, table of contents .\" data-hash=\"\" data-license=\"OPEN ACCESS\" data-source=\"https://journals.lww.com/anesthesia-analgesia/fulltext/2008/01000/intraoperative_contralateral_tension_pneumothorax.9.aspx\" data-tags=\"\" height=\"444\" src=\"https://image.prepladder.com/content/5Ph4FJGyhJ6S9UJgvAlC1745402801.png\" width=\"466\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Ovoid air collection</li>\n<li>Close to the chest wall</li>\n<li>Pleural adhesions are seen as line shadows</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Weerakkody Y, Di Muzio B, Bell D\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/articles/loculated-pneumothorax\" data-tags=\"\" height=\"490\" src=\"https://image.prepladder.com/content/3O4NAj6L73A1IT7CM64z1745402807.png\" width=\"466\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 1-day-old neonate has not passed urine since birth. What is the next step in management?", "options": [{"label": "A", "text": "Continue breast feeding and observe", "correct": true}, {"label": "B", "text": "Admit to NICU", "correct": false}, {"label": "C", "text": "Start artificial feeding", "correct": false}, {"label": "D", "text": "Start intravenous fluids", "correct": false}], "correct_answer": "A. Continue breast feeding and observe", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - Continue &lt;span class=\"customMeta\" data-dictid=\"823f77f5f016927771832f26523597\"&gt;breast feeding&lt;/span&gt; and observ\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient underwent surgery for the varicose vein. He now complains of sensory loss over the medial aspect of the leg and foot. Which of the following nerves is most likely to be injured?", "options": [{"label": "A", "text": "Sural nerve", "correct": false}, {"label": "B", "text": "Superficial peroneal nerve", "correct": false}, {"label": "C", "text": "Deep peroneal nerve", "correct": false}, {"label": "D", "text": "Saphenous nerve", "correct": true}], "correct_answer": "D. Saphenous nerve", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/md5VsEhyOYfHlr7yjaDa1746251454.png", "https://image.prepladder.com/notes/f7kba388FnzHC51MbWlE1746251391.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:588px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Region</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Dermatome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Nerve Supply</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Heel (Skin on the heel)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>S1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"f2a519f38316927772004fe7c606af\">tibial</span> nerve has two branches</p>\n<ul>\n<li>Lateral <span class=\"customMeta\" data-dictid=\"a7a430f3a9169277719510c13f434d\">plantar</span> nerve <strong>S1</strong> towards the<strong> little toe</strong>.</li>\n<li>Medial <span class=\"customMeta\" data-dictid=\"a7a430f3a9169277719510c13f434d\">plantar</span> nerve<strong> L5</strong> towards the<strong> great toe</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The popliteal region, <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> thigh (middle), calf, <span class=\"customMeta\" data-dictid=\"befda305051692777195a95ee0695a\">perineal</span> region</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>S2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Posterior <span class=\"customMeta\" data-dictid=\"94f1c8df1f1692777185bd6a7c3fff\">cutaneous</span> nerve</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lateral foot, <span class=\"customMeta\" data-dictid=\"f61866c72d169277718680f9c96ff2\">dorsum</span> of the foot</strong> (Little toe)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>S1</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sural nerve</p>\n<p><strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>First web space </strong>(Dorsum)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>L5 <strong> </strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Deep <span class=\"customMeta\" data-dictid=\"1e6451edc31692777195c54367b1ad\">peroneal</span> nerve</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Medial aspect of leg</strong> (Medial malleolus)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>L4</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Saphenous nerve</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Inguinal region</strong> (Proximal lower limb)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>L1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ilioinguinal nerve, Genitofemoral nerve</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Anterior thigh</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>L2, L3, L4</p>\n<p>(Lateral to medial)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Femoral nerve</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Medial thigh</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>L2, L3, L4</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Obturator nerve</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Perineum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>S2, S3, S4</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pudendal nerve</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 7-year-old boy presented with abdominal pain, vomiting, oliguria, and periorbital puffiness following chemotherapy. Investigations reveal hyperuricemia, raised creatinine levels, and hyperkalemia. What is the next best step in the management of this condition?", "options": [{"label": "A", "text": "Hydration", "correct": true}, {"label": "B", "text": "Probenecid", "correct": false}, {"label": "C", "text": "Allopurinol", "correct": false}, {"label": "D", "text": "Rasburicase", "correct": false}], "correct_answer": "A. Hydration", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - H\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The structure marked A in the image below gives rise to which of the following structures?", "options": [{"label": "A", "text": "Gastrosplenic ligament", "correct": false}, {"label": "B", "text": "Lienorenal ligament", "correct": false}, {"label": "C", "text": "Falciform ligament", "correct": true}, {"label": "D", "text": "Gastrophrenic ligament", "correct": false}], "correct_answer": "C. Falciform ligament", "question_images": ["https://image.prepladder.com/notes/2KN90rrJQVdxMlkYMicn1746251589.png"], "explanation_images": ["https://image.prepladder.com/content/qBZ4czkbdt5wKUAyuB6L1745403247.png", "https://image.prepladder.com/content/kk8b2OOfDZayKIETIvZf1745403271.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:694px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:1px solid #a2a9b1; vertical-align:top\">\n<p><strong>Sources</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:1px solid #a2a9b1; vertical-align:top\">\n<p><strong>Structure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:1px solid #a2a9b1; vertical-align:top\">\n<p><strong>From</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:1px solid #a2a9b1; vertical-align:top\">\n<p><strong>To</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:1px solid #a2a9b1; vertical-align:top\">\n<p><strong>Contains</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Dorsal mesentery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Greater omentum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Greater <span class=\"customMeta\" data-dictid=\"4bd67d54f016927771850c953dadbc\">curvature</span> of stomach (and spleen)</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Transverse colon</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>right and left <span class=\"customMeta\" data-dictid=\"4a2f01d90816927771883e2bc0844f\">gastroepiploic</span> vessels and fat</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Gastrosplenic ligament</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Stomach</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Spleen</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Short <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> artery, Left <span class=\"customMeta\" data-dictid=\"4a2f01d90816927771883e2bc0844f\">gastroepiploic</span> artery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Gastrophrenic ligament</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Stomach</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Diaphragm</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Left <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> <span class=\"customMeta\" data-dictid=\"80686f198416927771959402f37ba8\">phrenic</span> artery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Gastrocolic ligament</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Stomach</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Transverse colon</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Right <span class=\"customMeta\" data-dictid=\"4a2f01d90816927771883e2bc0844f\">gastroepiploic</span> artery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Splenorenal ligament</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Spleen</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Kidney</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Splenic artery, Tail of pancreas</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Ventral mesentery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Lesser omentum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Lesser <span class=\"customMeta\" data-dictid=\"4bd67d54f016927771850c953dadbc\">curvature</span> of the stomach (and duodenum)</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Liver</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>The right free margin-hepatic artery, <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> vein, and <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> duct,lymph nodes and the <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> vessels,hepatic <span class=\"customMeta\" data-dictid=\"3a9085a5761692777195417d7c03ae\">plexus</span> of nerve,all enclosed in <span class=\"customMeta\" data-dictid=\"a606b55b4316927771956c3cb0d383\">perivascular</span> <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> sheath. Along the lesser <span class=\"customMeta\" data-dictid=\"4bd67d54f016927771850c953dadbc\">curvature</span> of the stomach-left and right <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> artery,the <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> group of <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes and lymphatics, branches from the <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> nerve.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Hepatogastric ligament</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Stomach</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Liver</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Right and left <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> artery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Hepatoduodenal ligament</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Duodenum</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Liver</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Hepatic <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> proper, <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> <span class=\"customMeta\" data-dictid=\"a74252404f1692777196d3f24bde2d\">portal</span> vein, <span class=\"customMeta\" data-dictid=\"cf978047b61692777183c0569f21f2\">bile</span> duct, <span class=\"customMeta\" data-dictid=\"bd1c98736616927771820954b0a744\">autonomic</span> nerves</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:720px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:1px solid #a2a9b1; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Sources</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:1px solid #a2a9b1; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Structure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:1px solid #a2a9b1; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>From</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:1px solid #a2a9b1; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>To</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:1px solid #a2a9b1; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Contains</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Dorsal mesentery</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Mesentery proper</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Small <span class=\"customMeta\" data-dictid=\"7840cca3ed16927771901d2f6cb32b\">intestine</span> (jejunum and ileum)</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Posterior <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Superior mesenteric artery, accompanying veins, <span class=\"customMeta\" data-dictid=\"bd1c98736616927771820954b0a744\">autonomic</span> nerve plexuses, lymphatics, 100–200 <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes and <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue with fat</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Transverse mesocolon</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Transverse colon</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Posterior <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Middle colic</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Sigmoid mesocolon</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Sigmoid colon</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Pelvic wall</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Sigmoid arteries and superior rectal artery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Mesoappendix</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Mesentery of ileum</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Appendix</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Appendicular artery</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:728px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:1px solid #a2a9b1; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Sources</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:1px solid #a2a9b1; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Structure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:1px solid #a2a9b1; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>From</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:1px solid #a2a9b1; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>To</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:1px solid #a2a9b1; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Contains</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Ventral mesentery</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Falciform ligament</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Liver</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Thoracic diaphragm, <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Round <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> of liver, <span class=\"customMeta\" data-dictid=\"a68186fa3d1692777194d7b1b06fdc\">paraumbilical</span> vein</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Left <span class=\"customMeta\" data-dictid=\"9cc3973459169277720194a0847477\">umbilical</span> vein</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Round <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> of liver</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Liver</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Umbilicus</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Ventral mesentery</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Coronary ligament</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Liver</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Thoracic diaphragm</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Ductus venosus</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Ligamentum venosum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Liver</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Liver</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Phrenicocolic ligament</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Left colic flexure</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Thoracic diaphragm</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Ventral mesentery</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Left triangular ligament, right triangular ligament</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Liver</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Umbilical folds</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Urinary bladder</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Ileocecal fold</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Ileum</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Cecum</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Broad <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> of the uterus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Uterus</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Pelvic wall</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Mesovarium, mesosalpinx, mesometrium</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Round <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> of uterus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Uterus</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Inguinal canal</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:1px solid #a2a9b1; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p><strong>Suspensory <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> of the ovary</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Ovary</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Pelvic wall</p>\n</td>\n<td style=\"border-bottom:1px solid #a2a9b1; border-left:none; border-right:1px solid #a2a9b1; border-top:none; vertical-align:top\">\n<p>Ovarian artery</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A baby presented with abdominal pain. On examination, a mass is palpated in the left lumbar region. A barium enema is done, and the image is given below. What is the likely diagnosis?", "options": [{"label": "A", "text": "Intussusception", "correct": true}, {"label": "B", "text": "Volvulus", "correct": false}, {"label": "C", "text": "Duodenal atresia", "correct": false}, {"label": "D", "text": "Intestinal obstruction", "correct": false}], "correct_answer": "A. Intussusception", "question_images": ["https://image.prepladder.com/content/YBhrSl56qWHf6kVZANN71745403414.png"], "explanation_images": ["https://image.prepladder.com/content/NM2fPflrwP1hWBftZ7e01745403464.png", "https://image.prepladder.com/content/RdCvAIRYCOoCYaSYLoa81745403501.png", "https://image.prepladder.com/content/VeUOh8inLzGBKsDGMyXk1745403525.png", "https://image.prepladder.com/content/ihuCz794Y8JSUntPjaB01745403536.png", "https://image.prepladder.com/notes/25k1LnA7S9BHxRBB39CT1746424058.png"], "explanation": "<p>Correct Answer A - Intussu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the given structure.", "options": [{"label": "A", "text": "Lymph node", "correct": false}, {"label": "B", "text": "Glomerulus", "correct": false}, {"label": "C", "text": "Spleen", "correct": false}, {"label": "D", "text": "Pancreatic islet cells", "correct": true}], "correct_answer": "D. Pancreatic islet cells", "question_images": ["https://image.prepladder.com/notes/lfDQ5UEl9kq2gsGqvAXk1746253021.png"], "explanation_images": ["https://image.prepladder.com/notes/dvLSpR9gZTCVBEgRhGdz1746253092.png", "https://image.prepladder.com/notes/kHR7rBHlCxGyiqG3nR5b1746253194.png", "https://image.prepladder.com/notes/ptlRqk9aABHnPVS8UO3W1746253380.png", "https://image.prepladder.com/content/PROufn9BT166gQ6WqyWi1745403586.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the cartilage given below", "options": [{"label": "A", "text": "Non-articular hyaline cartilage", "correct": false}, {"label": "B", "text": "Articular hyaline cartilage", "correct": false}, {"label": "C", "text": "Yellow cartilage", "correct": false}, {"label": "D", "text": "White fibrocartilage", "correct": true}], "correct_answer": "D. White fibrocartilage", "question_images": ["https://image.prepladder.com/notes/uXVVzyMIVhS3dN2KzNnF1746253566.png"], "explanation_images": ["https://image.prepladder.com/notes/tCBwKyYdAO5Sxn9sBjN21746253662.png", "https://image.prepladder.com/notes/CuJ1qyxqkjGiI4FWp0B71746253707.png", "https://image.prepladder.com/notes/4rZ70Rc23HqR1fuxzTsx1746253794.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:810px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Characteristic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Hyaline <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">Cartilage</span> (Most Common) (Options A, B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Elastic <span class=\"customMeta\" data-dictid=\"c6f61cdbe41692777183fdc8f95f96\">Cartilage</span> (Yellow cartilage) (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Fibrocartilage</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Matrix appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Homogeneous, basophilic</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Contains <span class=\"customMeta\" data-dictid=\"2dba7c03f61692777187254f866bcc\">elastic</span> fiber network</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Numerous <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">collagen</span> bundles</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Chondrocyte arrangement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Groups (cell nests/isogenous groups)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Similar to hyaline</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Single rows or <span class=\"customMeta\" data-dictid=\"e2c83bc4de1692777190e11dbe140f\">isogenous</span> groups</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Perichondrium</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Present (except in <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">articular</span> cartilage)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Present</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Absent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Main <span class=\"customMeta\" data-dictid=\"3ace01719a1692777202ddafcebbc4\">fibre</span> type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Type II collagen</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elastic fibers</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Type I (primarily) and Type II collagen</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Main functions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Structural support forms <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">articular</span> surfaces</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Provides flexibility and resilience</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Resists <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> and shearing, shock absorption</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Examples</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Costal cartilage, <span class=\"customMeta\" data-dictid=\"c739a6fb2b1692777200e2ada8023c\">tracheal</span> rings, <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">articular</span> cartilage</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Auricle, epiglottis, <span class=\"customMeta\" data-dictid=\"f17057f75016927771829e70074368\">auditory</span> tube</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intervertebral discs, menisci</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with a unilateral throbbing headache, photophobia, and excessive lacrimation. He also complains of hemifacial pain on the clenching of teeth. On examination, pupillary reaction, light reflex, and accommodation reflex are normal. Which of the following marked nerves is involved in the above scenario?", "options": [{"label": "A", "text": "1", "correct": false}, {"label": "B", "text": "2", "correct": false}, {"label": "C", "text": "3", "correct": true}, {"label": "D", "text": "4", "correct": false}], "correct_answer": "C. 3", "question_images": ["https://image.prepladder.com/notes/e9P5Zpk1yuxvkbQSOnnS1746253941.png"], "explanation_images": ["https://image.prepladder.com/content/qaw7ydCmkqVvYkKksnJP1745403846.png", "https://image.prepladder.com/content/ecrVzpvNNT6zciEmUxWu1745403874.png", "https://image.prepladder.com/content/aEkMcXB6oeXWoKw6fMdm1745403878.png", "https://image.prepladder.com/content/LO5dMKfH0Qj6dNXONIhg1745403881.png", "https://image.prepladder.com/content/NsTNBS95LQZPgqHHBiiG1745403898.png", "https://image.prepladder.com/notes/zQ1C2YVBRFiK1BSjYGI41746255383.png", "https://image.prepladder.com/notes/9nqe4YtvIrJoNdArhtI11746255465.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:766px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Ophthalmic division (V1)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Maxillary division (V2)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mandibular division (V3)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sensory</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sensory</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mixed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Course </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"242\" src=\"https://image.prepladder.com/content/ecrVzpvNNT6zciEmUxWu1745403874.png\" width=\"200\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"367\" src=\"https://image.prepladder.com/content/aEkMcXB6oeXWoKw6fMdm1745403878.png\" width=\"200\"/></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"287\" src=\"https://image.prepladder.com/content/LO5dMKfH0Qj6dNXONIhg1745403881.png\" width=\"200\"/></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Branches </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Frontal </strong></p>\n<ul>\n<li>Supratrochlear</li>\n<li>Supraorbital</li>\n</ul>\n<p><strong>Nasociliary </strong></p>\n<ul>\n<li>Branch to the <span class=\"customMeta\" data-dictid=\"1be9f55b2d1692777184b9d813b17e\">ciliary</span> ganglion</li>\n<li>2–3 long <span class=\"customMeta\" data-dictid=\"1be9f55b2d1692777184b9d813b17e\">ciliary</span> nerves</li>\n<li>Posterior ethmoidal</li>\n<li>Infratrochlear</li>\n<li>Anterior ethmoidal</li>\n</ul>\n<p><strong>Lacrimal: </strong>Branch to the upper <span class=\"customMeta\" data-dictid=\"819ddea9e51692777187cdff06b437\">eyelid</span> and <span class=\"customMeta\" data-dictid=\"591ff46f251692777198992363d6f3\">secretomotor</span> fibres to the <span class=\"customMeta\" data-dictid=\"7a742b06701692777191bdca4f04a0\">lacrimal</span> gland.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Infraorbital</li>\n<li>Zygomaticofacial</li>\n<li>Zygomaticotemporal</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Mental</li>\n<li>Buccal</li>\n<li>Auriculo-temporal</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Supply </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Forehead</li>\n<li>Upper eyelids</li>\n<li>Root of nose</li>\n<li>Tip of nose</li>\n<li>Frontal air sinus</li>\n<li>Scalp</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Lower eyelids</li>\n<li>Lateral sides of the nose</li>\n<li>Upper lip</li>\n<li>Cheek (upper part)</li>\n<li>Anterior part of the <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> region</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Lower lip</li>\n<li>Chin</li>\n<li>Lower teeth</li>\n<li>Lower part of the cheek</li>\n<li>Lateral side (Upper 2/3rd) of auricle, <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> region</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An 8-day-old newborn was found to have thyroid-stimulating hormone levels of more than 100 mIU/L. Which of the following will be the next best investigation?", "options": [{"label": "A", "text": "Urine iodine excretion", "correct": false}, {"label": "B", "text": "Serum thyroid receptor antibody", "correct": false}, {"label": "C", "text": "Radiotracer uptake with technetium", "correct": true}, {"label": "D", "text": "Perchlorate secretion test", "correct": false}], "correct_answer": "C. Radiotracer uptake with technetium", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - &lt;span class=\"customMeta\" data-dictid=\"c5a32dfd6e1692777197db92b6aea1\"&gt;Radiotracer&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"cc20d2d7111692777201fb0caeb3f2\"&gt;uptake&lt;/span&gt; with technetiu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 10-month-old infant was brought with complaints of jerking movement of limbs towards the body. On examination, there is a regression in developmental milestones. Electroencephalogram shows hypsarrhythmia. Which of the following is the drug of choice in this condition?", "options": [{"label": "A", "text": "Phenytoin", "correct": false}, {"label": "B", "text": "Adrenocorticotropic hormone (ACTH)", "correct": true}, {"label": "C", "text": "Levetiracetam", "correct": false}, {"label": "D", "text": "Phenobarbitone", "correct": false}], "correct_answer": "B. Adrenocorticotropic hormone (ACTH)", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - &lt;span class=\"customMeta\" data-dictid=\"9bbbb7c9b316927771806ddc890ba2\"&gt;Adrenocorticotropic&lt;/span&gt; hormone (ACTH)</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>West Syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Age group</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Typically occurs between <strong>2 and 12 months of age.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Genetics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>ARX Gene Mutations</strong>: In males, <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to <span class=\"customMeta\" data-dictid=\"572b7955301692777181b851625681\">ambiguous genitalia</span> and <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> migration abnormalities.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Cryptogenic (Unknown Etiology)</strong>: Normal development before onset.</li>\n<li><strong>Symptomatic</strong>: Associated with developmental delays due to <span class=\"customMeta\" data-dictid=\"a0d3680eab1692777195d6ab932b14\">perinatal</span> issues, brain malformations, <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> disorders, or other causes.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Infantile <span class=\"customMeta\" data-dictid=\"eb8fb619d916927771879a8048d513\">Epileptic</span> Spasms</strong>: Clusters of spasms occurring mainly during drowsiness or upon waking.</li>\n<li><strong>Developmental Regression</strong></li>\n<li><strong>Hypsarrhythmia on EEG</strong>: A chaotic, high-voltage background with <span class=\"customMeta\" data-dictid=\"225e0697ea1692777193892a2c34c7\">multifocal</span> spikes.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>First-Line Treatment</strong>: Hormonal therapy, primarily <strong>ACTH </strong>(80 mg/mL)</p>\n<ul>\n<li><strong>Dosage</strong>: 150 units/m² daily (75 units/m² twice daily) for 2 weeks, then taper gradually.</li>\n<li><strong>Monitoring</strong>: EEGs at 1, 2, and 4 weeks to assess response.</li>\n<li>Early intervention is crucial, as a delay beyond 3 weeks can worsen the prognosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Alternative Treatments</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Oral Prednisolone</strong>: Lower-cost alternative (Less effective)</li>\n<li><strong>Vigabatrin</strong>: Used as a<strong> </strong>first-line agent in <span class=\"customMeta\" data-dictid=\"3fa45fe9451692777202810d42087f\">West syndrome</span> associated with <span class=\"customMeta\" data-dictid=\"93b7b2cfd31692777201efc538e5a2\">tuberous</span> <span class=\"customMeta\" data-dictid=\"dae4dea0581692777198fdef9fa684\">sclerosis</span> complex (TSC) or second-line if hormonal therapy fails. Side effects include <span class=\"customMeta\" data-dictid=\"fb7a2c30e416927771972f7df6f8c0\">retinal</span> toxicity.</li>\n<li><strong>Ketogenic Diet</strong>: Considered a third-line therapy.</li>\n<li><strong>Other Medications</strong>: Valproate, benzodiazepines (nitrazepam, clonazepam), topiramate, lamotrigine, zonisamide, pyridoxine, and IVIG. These drugs can help reduce <span class=\"customMeta\" data-dictid=\"5710e3461816927771987151d61aef\">seizure</span> frequency and severity but are not uniformly effective and may be used alongside <span class=\"customMeta\" data-dictid=\"55fd11666f1692777180e80135bda8\">ACTH</span> or <span class=\"customMeta\" data-dictid=\"5f0e6fea08169277720200e195878b\">vigabatrin</span> in cases with incomplete response.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Side Effects and Precautions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Side Effects of Hormonal Therapy</strong>: Hypertension, <span class=\"customMeta\" data-dictid=\"2e0552462e16927771871413861fb7\">electrolyte</span> imbalance, infections, hyperglycemia, and <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> ulcers.</li>\n<li><strong>Vaccination</strong>: Live vaccines are contraindicated, and other vaccines may be ineffective during and shortly after hormonal therapy.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 2-month-old infant born to an HIV-positive mother presents with recurrent diarrhea. What is the next best step?", "options": [{"label": "A", "text": "Test stool for giardia and give antibiotics", "correct": false}, {"label": "B", "text": "Dried spot sample for HIV DNA PCR", "correct": true}, {"label": "C", "text": "Antibody test for HIV", "correct": false}, {"label": "D", "text": "Aerobic culture", "correct": false}], "correct_answer": "B. Dried spot sample for HIV DNA PCR", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - Dried spot sample for &lt;span class=\"customMeta\" data-dictid=\"fa9d83d3d41692777189a8b393dd60\"&gt;HIV&lt;/span&gt; DNA PCR</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>&lt; 24 Months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li><strong>Antibody Tests:</strong> Not reliable for <span class=\"customMeta\" data-dictid=\"32b854324a1692777185c6c79fdc99\">definitive</span> diagnosis due to <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> <span class=\"customMeta\" data-dictid=\"9d7a12cab116927771811a0079086d\">antibody</span> presence.</li>\n<li><strong>IgA &amp; <span class=\"customMeta\" data-dictid=\"e4a6fd7fbb169277718986a699e800\">IgM</span> Tests:</strong> Not clinically useful d/t poor sensitivity and specificity.</li>\n<li><strong>Viral <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">Diagnostic</span> Tests:</strong>\n<ul>\n<li><strong>HIV DNA PCR:</strong> Highly sensitive and specific by two weeks of age.</li>\n<li><strong>HIV <span class=\"customMeta\" data-dictid=\"cc65bdc03f169277719726a675e8a7\">RNA</span> PCR:</strong> Similar to DNA PCR.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>&gt; 24 Months</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>IgG <span class=\"customMeta\" data-dictid=\"9d7a12cab116927771811a0079086d\">Antibody</span> Tests:</strong> Reliable if repeatedly positive, confirmed with <span class=\"customMeta\" data-dictid=\"fa9d83d3d41692777189a8b393dd60\">HIV</span> PCR.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Testing Protocols</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Rapid <span class=\"customMeta\" data-dictid=\"fa9d83d3d41692777189a8b393dd60\">HIV</span> Tests </strong>are useful for immediate diagnosis in newborns, but positive results must be confirmed with a second test or PCR.</li>\n<li>For<strong> breastfed infants</strong>, test 12 weeks after <span class=\"customMeta\" data-dictid=\"5af45ba59c16927771837f3aa7b6d9\">breastfeeding</span> ends to detect any potential infection <span class=\"customMeta\" data-dictid=\"0f0b2969921692777180de24f0b0c0\">acquired</span> through lactation.</li>\n<li><strong>High-Risk Infants:</strong> Initial <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> testing within the first 12-24 hours, followed by additional tests at 2-3 weeks, 4-8 weeks, and 4-6 months if needed.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definitive Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>For nonbreastfed infants, <span class=\"customMeta\" data-dictid=\"fa9d83d3d41692777189a8b393dd60\">HIV</span> infection can be excluded with</p>\n<ul>\n<li>Two negative <span class=\"customMeta\" data-dictid=\"8c5d4859ee16927772024f8b7d3c1c\">virologic</span> tests at ≥1 month and ≥4 months</li>\n<li>Two negative <span class=\"customMeta\" data-dictid=\"9d7a12cab116927771811a0079086d\">antibody</span> tests at ≥6 months.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An 8-year-old child has difficulty walking and getting up from a squatting position. A muscle biopsy was done and is shown in the image. Which of the following is true about this condition?", "options": [{"label": "A", "text": "Death occurs in 3 rd decade", "correct": true}, {"label": "B", "text": "Previous history of viral prodrome", "correct": false}, {"label": "C", "text": "It is a mitochondrial storage disorder", "correct": false}, {"label": "D", "text": "Early treatment has an excellent prognosis", "correct": false}], "correct_answer": "A. Death occurs in 3 rd decade", "question_images": ["https://image.prepladder.com/notes/slHwdG8LNYFAEk05jayX1746424194.png"], "explanation_images": ["https://image.prepladder.com/content/l8KTDMWIeFDFpblIDV4l1745404816.png", "https://image.prepladder.com/content/fY3h5vhHmoCOkQNrmBK31745404820.png"], "explanation": "<p>Correct Answer A - Death occurs in 3rd decade:</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Duchenne <span class=\"customMeta\" data-dictid=\"9e2d8a3f5a16927771932c2348ec52\">Muscular</span> <span class=\"customMeta\" data-dictid=\"04568e3d19169277718672d9da94fd\">Dystrophy</span> (DMD)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Inheritance Pattern</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>X-linked recessive</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Type of Mutation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Frameshift mutations leading to a disrupted reading frame</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Dystrophin Protein</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Dystrophin deficient</li>\n<li>Truncated and unstable (&lt; 3% of normal)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Age of Onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Before 5 years</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clinical Severity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Severe, early onset, rapid progression</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Early Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hip <span class=\"customMeta\" data-dictid=\"a1d37a92d41692777188e12a817797\">girdle</span> weakness, delayed walking, <strong>Gowers’ sign</strong>, <span class=\"customMeta\" data-dictid=\"ba30a2b6501692777191b4178334d3\">lordotic</span> posture, frequent falls</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Ambulation Loss</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Typically between 10-14 years</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Progression Rate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rapid</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Muscle Involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Proximal muscle weakness, calf pseudohypertrophy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Cardiac Involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common, usually worsens after loss of ambulation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Cognitive Impairment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common (20-30% with IQ &lt; 70), possible autism-like behavior, epilepsy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Respiratory Involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common, leading to frequent <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> infections, sleep apnea, and <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> failure</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Initial Genetic Evaluation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Primary Testing:</strong> Deletion/duplication analysis of the <span class=\"customMeta\" data-dictid=\"4b0ac15f9316927771862866d6d51f\">dystrophin</span> gene using <span class=\"customMeta\" data-dictid=\"b5bd69c9791692777186a40f45ffb6\">dosage</span> analysis.</li>\n<li>Next-generation sequencing (NGS) if initial testing is negative.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Muscle Biopsy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Indications:</strong> <strong>Used when genetic tests are inconclusive,</strong> especially if <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> CK levels are elevated.</li>\n<li><strong>Findings:</strong> Endomysial <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue proliferation, degenerating/regenerating myofibers, hypercontracted fibers, <span class=\"customMeta\" data-dictid=\"4b0ac15f9316927771862866d6d51f\">dystrophin</span> abnormalities.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Steroid Therapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Purpose:</strong> Slows <span class=\"customMeta\" data-dictid=\"cba1b0e9ae1692777193338c1ab85f\">muscle strength</span> decline, prolongs ambulation, and may benefit <span class=\"customMeta\" data-dictid=\"a3e3b052331692777198750eaae63a\">scoliosis</span> progression.</li>\n<li><strong>Dosing:</strong> Prednisone (0.75 mg/kg/day) or deflazacort (0.9 mg/kg/day); various dosing protocols available.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Life Expectancy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Late teens to 20s</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following children are considered at-risk babies? Baby with a birth weight of 2.5 kg Baby on artificial feeding Baby of working mother/single parent Baby with weight &amp;lt;85% of expected weight Birth order of 3 or more", "options": [{"label": "A", "text": "2, 3", "correct": true}, {"label": "B", "text": "1, 2, 3, 4", "correct": false}, {"label": "C", "text": "4, 5", "correct": false}, {"label": "D", "text": "1, 4", "correct": false}], "correct_answer": "A. 2, 3", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - 2, 3\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the condition?", "options": [{"label": "A", "text": "Bladder exstrophy", "correct": true}, {"label": "B", "text": "Omphalocele", "correct": false}, {"label": "C", "text": "Persistent vitellointestinal duct", "correct": false}, {"label": "D", "text": "Gastroschisis", "correct": false}], "correct_answer": "A. Bladder exstrophy", "question_images": ["https://image.prepladder.com/content/uVd9gHeeCxB41xhICQOF1745406614.png"], "explanation_images": ["https://image.prepladder.com/content/2TK5K9W5kNBKEbf8UNxV1745406658.png", "https://image.prepladder.com/content/WBkKTh1oSbwuP9ObB9nD1745406738.png", "https://image.prepladder.com/content/aW9hEXodKEJt0reNEf4s1745406745.png", "https://image.prepladder.com/notes/enjNBCc2Vee8PnSSTyVj1746424314.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Disruption in normal development during pregnancy.</li>\n<li>Exact triggers remain unclear.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathology &amp; Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Improper development of the cloacal membrane.</strong></li>\n<li>Early <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> leads to <span class=\"customMeta\" data-dictid=\"09d15ca64a1692777187c47fbb9420\">epispadias</span> (incomplete urethral formation).</li>\n<li>Later <span class=\"customMeta\" data-dictid=\"e73553a3a5169277719787fd5f4680\">rupture</span> results in <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> exstrophy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Spectrum from simple <span class=\"customMeta\" data-dictid=\"09d15ca64a1692777187c47fbb9420\">epispadias</span> to more complex forms of <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> exstrophy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Males</strong>:</p>\n<ul>\n<li>Shortened <span class=\"customMeta\" data-dictid=\"028d70d3e11692777195f204ee2764\">penis</span> due to <span class=\"customMeta\" data-dictid=\"fff48ca9da16927771966fd16bbacc\">pubic</span> bone separation (diastasis of the <span class=\"customMeta\" data-dictid=\"fff48ca9da16927771966fd16bbacc\">pubic</span> symphysis).</li>\n<li>Widely spaced <span class=\"customMeta\" data-dictid=\"c0f500688016927771854a06750f2e\">crura</span> (internal, <span class=\"customMeta\" data-dictid=\"b2a22f1dff169277719977c0a8ee4a\">spongy</span> columns within the penis).</li>\n<li>Underdeveloped <span class=\"customMeta\" data-dictid=\"62cebb95301692777185304f785d5b\">corporeal</span> tissue (erectile tissue).</li>\n</ul>\n<p><strong>Females</strong>:</p>\n<ul>\n<li>Shortened and narrowed vagina, often positioned more anteriorly.</li>\n<li>Bifid <span class=\"customMeta\" data-dictid=\"730ba6fe50169277718492019976c7\">clitoris</span> (split into two parts).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Urinary function issues.</li>\n<li>Increased risk of infections.</li>\n<li>Risk factor for Adenocarcinoma.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Surgical Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Cover the <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> with a wet <span class=\"customMeta\" data-dictid=\"fc3d080799169277719904701c07f9\">sterile</span> plastic wrap and plan for surgery.</li>\n</ul>\n<p><strong>Surgical repair, in multiple stages.</strong></p>\n<ul>\n<li>Steps Include:</li>\n<li>Closing the <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> and placing it back inside the body.</li>\n<li>Reconstructing the urethra.</li>\n<li>Repairing the <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall defect.</li>\n<li>Addressing <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">genital</span> abnormalities to ensure normal function and appearance.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Omphalocele (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Gastroschisis (Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Herniation of <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> contents that fails to return back</p>\n<p style=\"text-align:center\"><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"344\" src=\"https://image.prepladder.com/content/WBkKTh1oSbwuP9ObB9nD1745406738.png\" width=\"343\"/></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Evisceration of <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> contents through a <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> in the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall just <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> to the umbilicus</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Centers for Disease Control and Prevention\" data-hash=\"\" data-license=\"OPEN ACCESS\" data-source=\"https://en.wikipedia.org/wiki/Gastroschisis#/media/File:Gastroschisis-web.jpg\" data-tags=\"\" height=\"273\" src=\"https://image.prepladder.com/content/aW9hEXodKEJt0reNEf4s1745406745.png\" width=\"455\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Defect through <strong>central umbilicus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Defect through<strong> right of umbilicus</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Three-layer <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> covering present (peritoneum, Wharton's <span class=\"customMeta\" data-dictid=\"88bc2baef31692777190f5b09925aa\">jelly</span> &amp; <strong>amnion</strong>)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Membrane cover absent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Associated with aneuploidies</strong>, genetic syndromes (eg. Beckwith -Wiedemann) and other <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> anomalies</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Associated anomalies rare.</li>\n<li>Gut malrotation/bowel <span class=\"customMeta\" data-dictid=\"5c10d19e4416927771829871a1737f\">atresia</span> may be seen.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Poor <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> in long term due to associated anomalies</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Better prognosis</strong> in long term</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A previously healthy child presented with acute-onset dyspnea. A chest X-ray shows unilateral hyperinflation of the lung. What is true for this patient?", "options": [{"label": "A", "text": "Focal area of decreased air entry will be suggestive of foreign body", "correct": true}, {"label": "B", "text": "Flexible bronchoscopy used for removal", "correct": false}, {"label": "C", "text": "In complete obstruction, ball and valve mechanism causes hyperinflation", "correct": false}, {"label": "D", "text": "The child has developed acute laryngotracheobronchitis", "correct": false}], "correct_answer": "A. Focal area of decreased air entry will be suggestive of foreign body", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - &lt;span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\"&gt;Focal&lt;/span&gt; area of decreased air entry will be suggestive of foreign body:</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Prevalence </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Choking is a leading cause of <span class=\"customMeta\" data-dictid=\"9b7604d5461692777192546af7cabd\">morbidity</span> and mortality in children, especially those under 4 years old.</li>\n<li>Most victims are older infants and toddlers.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common Objects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Food items: Nuts, seeds, hard candy, gum, bones, raw fruits and vegetables.</li>\n<li>Inorganic objects: Coins, <span class=\"customMeta\" data-dictid=\"60088572d31692777191346a90b73f\">latex</span> balloons, pins, jewelry, magnets, pen <span class=\"customMeta\" data-dictid=\"8612e87d8f1692777183b907ef4722\">caps</span> and toys.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Location </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bronchus &gt; <span class=\"customMeta\" data-dictid=\"9ebd78bd471692777200ede69e8ed1\">Trachea</span> &gt; Larynx</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Types </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Partial obstruction: </strong></p>\n<ul>\n<li>This causes a <strong>ball <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> effect that leads to <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> hyperinflation</strong> of the affected lung area (a bronchial foreign body blocks the exit of air from the obstructed lung during expiration).<strong> (Option C)</strong></li>\n<li>Overlying the <span class=\"customMeta\" data-dictid=\"06e0403a9c16927771846fde1c53f8\">chest wall</span> shows<strong> hyperresonance, diminished vocal <span class=\"customMeta\" data-dictid=\"37b9856df8169277719716b550a15f\">resonance</span> and poor air entry.</strong></li>\n</ul>\n<p><strong>Complete Obstruction:</strong></p>\n<ul>\n<li>Cause <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"7a5ca69ddf16927771829cd4e4d464\">atelectasis</span> and <span class=\"customMeta\" data-dictid=\"56a39e9dae169277719923b12d72d1\">suppuration</span> of surrounding <span class=\"customMeta\" data-dictid=\"e46d46c1521692777194d02f11f83b\">parenchyma</span> of lungs result in bronchiectasis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Manifestation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Initial Event: </strong>Coughing, choking, gagging, potential <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> obstruction. Some children may expel the foreign body during this stage.</li>\n<li><strong>Asymptomatic Interval: </strong>Immediate symptoms subside; foreign body remains lodged. Can be misleading and lead to delayed diagnosis.</li>\n<li><strong>Complications: </strong>Fever, cough, hemoptysis, pneumonia, atelectasis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Positive history is crucial.</li>\n<li>Plain Films: Recommended first; may miss <span class=\"customMeta\" data-dictid=\"17825c11c616927771979bd9b0b285\">radiolucent</span> objects (80-96%).</li>\n<li>Expiratory Films: Reveal secondary findings like air trapping, asymmetric hyperinflation.</li>\n<li>CT Scan: High sensitivity and <span class=\"customMeta\" data-dictid=\"e70dd3ea9916927771988faba61d64\">specificity</span> but involves radiation.</li>\n<li>Bronchoscopy: Should be performed if suspicion remains despite negative or inconclusive imaging.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Prompt <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">endoscopic</span> removal with a rigid bronchoscope. (Option B)</strong></li>\n<li>Appropriate antibiotics are given for secondary infection.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A male child presented with arthralgia and abdominal pain. On examination, there was palpable purpura over the lower limb. There is a past history of upper respiratory tract infection prior to the onset of presenting symptoms. Which of the following is the treatment for this condition?", "options": [{"label": "A", "text": "Azathioprine", "correct": false}, {"label": "B", "text": "Methotrexate", "correct": false}, {"label": "C", "text": "Cyclosporine", "correct": false}, {"label": "D", "text": "Glucocorticoids", "correct": true}], "correct_answer": "D. Glucocorticoids", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Exact cause unknown.</li>\n<li>Immune-mediated vasculitis, often following an upper <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> infection.</li>\n<li>Genetic predisposition, with <strong>HLA-B34 and DRB1</strong> observed in some cases.</li>\n<li>Most common in <strong>males.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathology and Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Inflammation of <strong>small blood vessels</strong> affecting skin, joints, intestines, and kidneys.</li>\n<li>Triggered by immune system response to infections.</li>\n<li>Leakage of fluid and blood cells into tissues.</li>\n<li><strong>Immune complex deposition,</strong> particularly <strong>IgA</strong>, in affected vessels.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Palpable Purpura</strong>: Raised, purplish-red rash, <strong>mainly on legs and buttocks.</strong></li>\n<li><strong>Joint Involvement</strong>: Joint swelling, commonly in knees and ankles.</li>\n<li><strong>Abdominal Pain</strong>: Often severe, may include vomiting, diarrhea, <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> bleeding, or intussusception<strong>.</strong></li>\n<li><strong>Renal Involvement:</strong> Less common, presents as Chronic <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Criteria:</strong></p>\n<p><strong>Palpable purpura</strong> plus at least one of:</p>\n<ol>\n<li>Diffuse <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain</li>\n<li>Arthritis or arthralgia</li>\n<li>Biopsy-proven <span class=\"customMeta\" data-dictid=\"68bae589ad169277718918627baff4\">IgA</span> deposition</li>\n<li>Renal involvement</li>\n</ol>\n<p> </p>\n<p><strong>Laboratory involvement:</strong></p>\n<ul>\n<li>Elevated <span class=\"customMeta\" data-dictid=\"49069760291692777187e0e72db819\">ESR</span> or <span class=\"customMeta\" data-dictid=\"4df81a22571692777185a288d3c63d\">CRP</span> indicating inflammation.</li>\n<li>Platelet Counts are normal.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Intussusception.</li>\n<li>Chronic <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> Failure due to Long-term <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> damage, in severe cases.</li>\n<li>Neurological Complications: Rare; may include seizures, headaches, or <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> neuropathy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Mild Cases: Rest, hydration, and pain relievers.</li>\n<li>Moderate to Severe Cases: <strong>Corticosteroids (e.g., prednisone)</strong> to reduce inflammation.</li>\n<li>Severe or Resistant Cases: Additional <span class=\"customMeta\" data-dictid=\"c3c986cd721692777189b473814b2e\">immunosuppressive</span> medications may be required.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Full recovery in most cases.</li>\n<li>Variable based on <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> involvement.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 10-year-old presents with edema and anasarca. A diagnosis of minimal change disease is made. Which of the following is true about this condition?", "options": [{"label": "A", "text": "Light microscopy shows effacement of podocytes", "correct": false}, {"label": "B", "text": "Good response to steroids", "correct": true}, {"label": "C", "text": "Most common in adults", "correct": false}, {"label": "D", "text": "Non-selective proteinuria", "correct": false}], "correct_answer": "B. Good response to steroids", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - Good response to steroids</p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Minimal Change Disease (MCD)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Nephrotic syndrome: Edema, <strong>heavy selective proteinuria</strong>, but normal <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> function <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Age </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Appears between <strong>2 to 6 years</strong> of age<strong> (Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Proteinuria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Heavy (3+ to 4+) on dipstick</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hematuria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rare, <span class=\"customMeta\" data-dictid=\"79067cb33316927771926965c3c0b5\">microscopic</span> <span class=\"customMeta\" data-dictid=\"660645b0c91692777188bbdf3fedff\">hematuria</span> may occur</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Urinary Casts</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hyaline and <span class=\"customMeta\" data-dictid=\"4f63eb15be169277718848d4b4978b\">granular</span> casts</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Serum Albumin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low (&lt;1 g/dL)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Blood <span class=\"customMeta\" data-dictid=\"38d4be106e169277720105b006c26b\">Urea</span> and Creatinine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal unless <span class=\"customMeta\" data-dictid=\"b93b1c964f16927771894edc409f80\">hypovolemia</span> or <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> injury</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Serum <span class=\"customMeta\" data-dictid=\"f0ff39a3fa1692777184cf743ca1e7\">Complement</span> C3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cholesterol</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hypercholesterolemia (may cause <span class=\"customMeta\" data-dictid=\"70da66640f16927771920de556da59\">milky</span> plasma)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>ASO/Anti-DNase B Titers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Not elevated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Light Microscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Glomeruli appears normal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Electron Microscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diffuse <span class=\"customMeta\" data-dictid=\"dc0035cd191692777187b9b8b2af69\">effacement</span> </strong>of podocytes.<strong> (Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Corticosteroid </strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 10-year-old child presents with diarrhea and weight loss. On examination, the height and weight are lesser than expected. Laboratory investigations were positive for class II HLA-DQ2. Which of the following will you advise the child?", "options": [{"label": "A", "text": "Fat-free diet", "correct": false}, {"label": "B", "text": "Lactose-free diet", "correct": false}, {"label": "C", "text": "Low carbohydrate diet", "correct": false}, {"label": "D", "text": "Gluten-free diet", "correct": true}], "correct_answer": "D. Gluten-free diet", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/HQZHY47YzOm9xxKU8nbo1745407667.png", "https://image.prepladder.com/content/9Ys91tyooszWIP4wV43s1745407656.png"], "explanation": "<p>Correct Answer D - Gluten-free diet</p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Serology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Anti-tTG (Tissue Transglutaminase)</li>\n<li>Anti EMA (Endomysial antibody)</li>\n<li>Anti-DGP (Deamidated <span class=\"customMeta\" data-dictid=\"21f6d7d8df1692777188deb1006c47\">gliadin</span> peptide)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Upper GI endoscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"a9e7c4b7051692777187a218b539d7\">endoscopy</span> may be normal or show the<strong> absence of folds</strong> or scalloped duodenal folds.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histopathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Villous atrophy/</strong>Flat villi</li>\n<li><strong>Crypt hyperplasia</strong></li>\n<li>Intraepithelial <span class=\"customMeta\" data-dictid=\"c605d4126116927771916c2002638e\">lymphocyte</span> infiltration.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Nephron\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Celiac_disease_-_high_mag.jpg\" data-tags=\"\" height=\"347\" src=\"https://image.prepladder.com/content/9Ys91tyooszWIP4wV43s1745407656.png\" width=\"399\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child presented with a history of loose stools with an increase in frequency for 4 days. On examination, he is drowsy, unable to feed, and skin on pinching goes back very slowly. According to the integrated management of neonatal and childhood illness (IMNCI), thischild will be classified as having:", "options": [{"label": "A", "text": "Mild dehydration", "correct": false}, {"label": "B", "text": "Some dehydration", "correct": false}, {"label": "C", "text": "Severe dehydration", "correct": true}, {"label": "D", "text": "Moderate dehydration", "correct": false}], "correct_answer": "C. Severe dehydration", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Sign/Symptom</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>No/Mild <span class=\"customMeta\" data-dictid=\"da07fd59a11692777185e23c69af5e\">Dehydration</span> </strong></p>\n<p style=\"text-align: center;\"><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Some <span class=\"customMeta\" data-dictid=\"da07fd59a11692777185e23c69af5e\">Dehydration</span> (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Severe Dehydration</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mental status</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Alert</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Irritable/restless</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Lethargic/unconscious</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Thirst</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Normal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Increased</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Unable to drink</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Eyes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Normal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Slightly sunken</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Very sunken</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Tears</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Present</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Decreased</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Absent</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mouth</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Moist</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Dry</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Parched</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Skin turgor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Normal (Immediate skin recoil)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Slow <span class=\"customMeta\" data-dictid=\"b45dda9ea71692777197cbb7b1cab1\">recoil</span> (2-3sec)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Very slow <span class=\"customMeta\" data-dictid=\"b45dda9ea71692777197cbb7b1cab1\">recoil</span> (&gt;3sec)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Capillary refill</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Normal (&lt;2sec)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Prolonged (2-3sec)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Prolonged (&gt;3sec)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Urine output</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Normal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Decreased</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Minimal</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Please identify the manoeuvre being executed in the image provided.", "options": [{"label": "A", "text": "Head tilt, chin lift", "correct": true}, {"label": "B", "text": "Jaw thrust", "correct": false}, {"label": "C", "text": "Head extension", "correct": false}, {"label": "D", "text": "In-line manual stabilization", "correct": false}], "correct_answer": "A. Head tilt, chin lift", "question_images": ["https://image.prepladder.com/notes/keb0chSAZb5hR2s7TqVe1745911456.jpg"], "explanation_images": ["https://image.prepladder.com/notes/keb0chSAZb5hR2s7TqVe1745911456.jpg", "https://image.prepladder.com/notes/XRfszIbpupl1KpDVqxyM1745911455.jpg"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 210 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 200 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "A 55-year-old male presented with verrucous carcinoma around the glans of the penis. Examination reveals that the inguinal lymph nodes are not enlarged. What is the appropriate management for this patient?", "options": [{"label": "A", "text": "Total penectomy", "correct": false}, {"label": "B", "text": "CO2 laser excision", "correct": false}, {"label": "C", "text": "Topical 5-fluorouracil", "correct": false}, {"label": "D", "text": "Partial penectomy", "correct": true}], "correct_answer": "D. Partial penectomy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:668px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Cancer Type/Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Localized Tumor - <span class=\"customMeta\" data-dictid=\"e62ab50e7a16927771882c6a886b18\">Glans</span> Only</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Partial penectomy</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Distal Penile Involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Partial <span class=\"customMeta\" data-dictid=\"9511f3dca216927771953e33166404\">penectomy</span> with 2cm margin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Proximal Penile Involvement</strong></p>\n<p><strong>/Anaplastic Tumors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p><strong>Total penectomy</strong> with <span class=\"customMeta\" data-dictid=\"befda305051692777195a95ee0695a\">perineal</span> urethrostomy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Carcinoma in situ, T1 Lesions, Well-Differentiated Tumors in Young </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Circumcision followed by <span class=\"customMeta\" data-dictid=\"0968038e2a1692777185ed087c7fd8\">curative</span> radiotherapy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Inguinal <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">Lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">Node</span> Involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Bilateral <span class=\"customMeta\" data-dictid=\"108e66d0571692777189ff4a5e8740\">ilioinguinal</span> <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> <span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\">node</span> dissection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Advanced Disease - T2 or Poorly Differentiated Tumors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Prophylactic inguinal nodal dissection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Carcinoma in situ</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Topical treatments (<strong>5-FU cream</strong>, imiquimod), Mohs surgery, <strong>laser therapy</strong>, or limited excision</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Chemotherapy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Combination <span class=\"customMeta\" data-dictid=\"8602c4b260169277718439bb122cb0\">chemotherapy</span> (5-FU, methotrexate, bleomycin, cisplatin, vincristine)</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p>Stage</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p>Description</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>TX</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Primary tumours cannot be assessed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>T0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>No evidence of a primary tumour</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Tis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Carcinoma <span class=\"customMeta\" data-dictid=\"96aaaa68ce1692777190096abe3c8a\">in situ</span> (Penile <span class=\"customMeta\" data-dictid=\"74b2ee426f169277719000793323ba\">intraepithelial</span> neoplasia, PeIN)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Ta</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Noninvasive localised <span class=\"customMeta\" data-dictid=\"5be0ee4ea316927771997104326685\">squamous</span> cell carcinoma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>T1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Tumor invades <span class=\"customMeta\" data-dictid=\"9864ad42b21692777191febeee1002\">lamina</span> propria, dermis, or <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue with/without lymphovascular or <span class=\"customMeta\" data-dictid=\"849a50eb4a1692777195de19bee5ed\">perineural</span> invasion</p>\n<ul>\n<li>T1a: without invasion/high grade</li>\n<li>T1b: with invasion/high grade</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>T2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Tumor invades <span class=\"customMeta\" data-dictid=\"7e902103fb16927771857729aade8b\">corpus</span> spongiosum with or without urethral invasion</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>T3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Tumor invades <span class=\"customMeta\" data-dictid=\"8c62bbe6721692777185d6892c1f31\">corpora</span> cavernosa with or without urethral invasion</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>T4</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Tumor invades adjacent structures (e.g., prostate, scrotum, <span class=\"customMeta\" data-dictid=\"fff48ca9da16927771966fd16bbacc\">pubic</span> bone)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>cNX</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Regional nodes cannot be assessed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>cN0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>No <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> or visible enlarged inguinal nodes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>cN1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Palpable mobile <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> inguinal <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> node</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>cN2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Palpable mobile <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> ≥2 inguinal <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>cN3</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Palpable fixed inguinal nodal mass or <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> <span class=\"customMeta\" data-dictid=\"344bcb4e391692777191307c1e0074\">lymphadenopathy</span> (unilateral or bilateral)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>cM0</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>No distant metastases</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>cM1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Distant metastases</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>pM1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Distant <span class=\"customMeta\" data-dictid=\"d3251bfb0b1692777192b069d7ba4a\">metastasis</span> microscopically confirmed</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the marked region in the given spirometry.", "options": [{"label": "A", "text": "Functional residual capacity", "correct": true}, {"label": "B", "text": "Tidal volume", "correct": false}, {"label": "C", "text": "Expiratory reserve volume", "correct": false}, {"label": "D", "text": "Inspiratory reserve volume", "correct": false}], "correct_answer": "A. Functional residual capacity", "question_images": ["https://image.prepladder.com/notes/U3bYWwE9VlTdXxMdNwa31745906236.png"], "explanation_images": ["https://image.prepladder.com/content/NDZfOxHwnGn14hW0tsfT1747629365.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Lung Volume/Capacity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Typical Volume (mL)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Formula</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tidal Volume (TV) </strong><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Amount of air inhaled or exhaled during normal breath</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>500</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>-</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inspiratory Reserve Volume (IRV) </strong><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Additional air that can be inhaled after a normal inhalation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3000</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>-</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Expiratory Reserve Volume (ERV) </strong><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Additional air that can be exhaled after a normal exhalation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1200</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>-</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Residual Volume (RV)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Air remaining in the lungs after a <span class=\"customMeta\" data-dictid=\"c678bddb1d1692777192d2ee1ebd92\">maximal</span> exhalation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1200</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>-</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anatomical Dead Space</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Volume of air in conducting airways where no gas exchange occurs</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>150</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>-</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Total Lung Capacity (TLC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Maximum amount of air the lungs can hold</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6000</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>TLC = TV + IRV + <span class=\"customMeta\" data-dictid=\"5a6905fdca16927771879daba1b8d2\">ERV</span> + RV</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vital Capacity (VC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Maximum air exhaled after a <span class=\"customMeta\" data-dictid=\"c678bddb1d1692777192d2ee1ebd92\">maximal</span> inhalation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4800</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>VC = TV + IRV + ERV</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inspiratory Capacity (IC)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Maximum air inhaled after a normal exhalation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3500</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>IC = TV + IRV</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Functional <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">Residual</span> Capacity (FRC) </strong><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Air remaining in the lungs after a normal exhalation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2400</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>FRC = <span class=\"customMeta\" data-dictid=\"5a6905fdca16927771879daba1b8d2\">ERV</span> + RV</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A man was brought to the emergency after suddenly becoming unconscious while working in the field. On examination, his temperature was 105 degrees fahrenheit and his skin turgor was decreased. Which of the following would not be seen in the patient?", "options": [{"label": "A", "text": "Tachypnea", "correct": false}, {"label": "B", "text": "Hypotension", "correct": false}, {"label": "C", "text": "Sweating", "correct": true}, {"label": "D", "text": "Red hot skin", "correct": false}], "correct_answer": "C. Sweating", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>System</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Key Changes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Thermoregulatory</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hyperthermia (&gt;40°C), <span class=\"customMeta\" data-dictid=\"12a6f23332169277718402ca6703e2\">cellular</span> <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> at extreme temperatures</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neurological</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Confusion, agitation, seizures, <span class=\"customMeta\" data-dictid=\"e39842f67b1692777184171cd1852a\">coma</span> (cerebral hypoperfusion, inflammation)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cardiovascular</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tachycardia, hypotension, distributive shock (vasodilation, <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> leakage)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Metabolic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acidosis (anaerobic metabolism), <span class=\"customMeta\" data-dictid=\"2e0552462e16927771871413861fb7\">electrolyte</span> imbalances (hyperkalemia, hyponatremia)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Renal</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>AKI (rhabdomyolysis, dehydration, <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> necrosis)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Respiratory</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tachypnea, Kussmaul breathing (severe acidosis)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hematological</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Endothelial damage, microthrombosis, DIC</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the procedure being performed in the image given below.", "options": [{"label": "A", "text": "Intraosseous cannula for pain relief", "correct": false}, {"label": "B", "text": "Bone marrow aspiration", "correct": false}, {"label": "C", "text": "Intraosseous route access for giving IV fluids", "correct": true}, {"label": "D", "text": "Bone marrow biopsy", "correct": false}], "correct_answer": "C. Intraosseous route access for giving IV fluids", "question_images": ["https://image.prepladder.com/notes/aXK54PAFb85tXo8jnbxW1745916342.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A diabetic patient presents with sudden-onset perineal pain. On examination, foul-smelling discharge and necrotic tissue, as seen in the image, are noted. Which of the following is true about the given condition?", "options": [{"label": "A", "text": "Anti-gas gangrene serum is indicated for all cases", "correct": false}, {"label": "B", "text": "Urinary diversion is the next step", "correct": false}, {"label": "C", "text": "A bilateral orchidectomy must be done", "correct": false}, {"label": "D", "text": "Mixed aerobic and anaerobic infection", "correct": true}], "correct_answer": "D. Mixed aerobic and anaerobic infection", "question_images": ["https://image.prepladder.com/notes/dMm6WwIc4a74v2T8Jo3U1745916336.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:617px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Fournier's Gangrene</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Definition</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Necrotizing infection</strong> of the soft tissues in the perineum, external genitalia, and <span class=\"customMeta\" data-dictid=\"fb89fe7db116927771957d22da5a71\">perianal</span> region, akin to <span class=\"customMeta\" data-dictid=\"f826a1a46e1692777193319fa1e5ed\">necrotizing</span> fasciitis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clinical Presentation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Symptoms:</strong> Intense pain in the genitalia, progressing through five phases:\n\t\t\t\t<ul>\n<li><strong>Prodromal Phase:</strong> Fever and lethargy.</li>\n<li><strong>Early Pain Phase:</strong> Intense pain, possible edema, pruritus.</li>\n<li><strong>Progressive Phase:</strong> Increased pain and erythema.</li>\n<li><strong>Crepitation Phase: </strong>Dusky skin with <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> crepitation.</li>\n<li><strong>Gangrene Phase:</strong> <span class=\"customMeta\" data-dictid=\"741c89cb18169277718889cfaafa53\">Gangrene</span> with <span class=\"customMeta\" data-dictid=\"0c02372a7d1692777196974ab1d772\">purulent</span> discharge.</li>\n</ul>\n</li>\n<li>Pain may decrease as <span class=\"customMeta\" data-dictid=\"741c89cb18169277718889cfaafa53\">gangrene</span> progresses.</li>\n<li>Severity ranges from <span class=\"customMeta\" data-dictid=\"8fb8df140b1692777191702bbc9358\">localized</span> <span class=\"customMeta\" data-dictid=\"169e1c9eb416927772006ea5a02252\">tenderness</span> to <span class=\"customMeta\" data-dictid=\"39f67d7dde16927771985d3952058d\">septic</span> shock.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Risk Factors</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Peripheral <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> disease, diabetes mellitus, malnutrition, alcoholism, <span class=\"customMeta\" data-dictid=\"a3cc9f976916927771895692a1a8a0\">immunocompromised</span> states.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Diagnosis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Clinical presentation supported by <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> or lab findings.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Management</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Initial Treatment:</strong>\n<ul>\n<li>Fluid resuscitation.</li>\n<li>Broad-spectrum antibiotics.</li>\n<li>Surgical debridement of necrotic tissue.</li>\n</ul>\n</li>\n<li><strong>Additional Measures:</strong>\n<ul>\n<li>Urinary and faecal <span class=\"customMeta\" data-dictid=\"73224cf5e516927771862db3f8f2f2\">diversion</span> to prevent wound contamination.</li>\n<li>Intensive monitoring for sepsis.</li>\n<li>Wound review and vacuum-assisted dressing.</li>\n<li>Skin <span class=\"customMeta\" data-dictid=\"6ca773c032169277718858b8ad1e9c\">grafting</span> post-infection control.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the correctly matched pair of substances with their renal clearance from the graph below.", "options": [{"label": "A", "text": "A-Glucose, B-РАН, С- Bicarbonate and D - Inulin", "correct": false}, {"label": "B", "text": "A-Glucose, B- Bicarbonate, C- Inulin and D - PAH", "correct": true}, {"label": "C", "text": "A-PAH, B-Inulin, C- Glucose and D - Bicarbonate", "correct": false}, {"label": "D", "text": "A-Inulin, B- Glucose, C - Bicarbonate and D PAH", "correct": false}], "correct_answer": "B. A-Glucose, B- Bicarbonate, C- Inulin and D - PAH", "question_images": ["https://image.prepladder.com/notes/TGMngWM32igx4G1XkiRi1745906236.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Substance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Key Feature</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>A (Glucose)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Zero</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fully reabsorbed in the <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> tubule; not excreted in urine.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>B (Bicarbonate)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less than GFR</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mostly reabsorbed by the kidneys, resulting in lower <span class=\"customMeta\" data-dictid=\"3a3fb1b8a816927771840e6a344cc0\">clearance</span> than GFR.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>C (Inulin)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Equal to GFR</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Filtered but neither reabsorbed <span class=\"customMeta\" data-dictid=\"fe5171bb0016927771933a5ca5d376\">nor</span> secreted; ideal for measuring GFR.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>D (PAH)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Greater than GFR</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Filtered and actively secreted; <span class=\"customMeta\" data-dictid=\"3a3fb1b8a816927771840e6a344cc0\">clearance</span> exceeds GFR.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inulin Clearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Used to measure <span class=\"customMeta\" data-dictid=\"1ad1e71a4a1692777188853097f685\">Glomerular</span> <span class=\"customMeta\" data-dictid=\"83d76f27051692777202029aee0cd3\">Filtration</span> Rate (GFR) as it is freely filtered but not reabsorbed or secreted.</li>\n<li>Not ideal for routine use due to <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> administration.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Creatinine Clearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Estimates GFR using creatinine, which is primarily filtered by the glomeruli.</li>\n<li>Slightly inaccurate due to <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> secretion, but practical for clinical settings.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>PAH Clearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Estimates <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">Renal</span> <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">Plasma</span> Flow (RPF).</li>\n<li>PAH is cleared through both <span class=\"customMeta\" data-dictid=\"1ad1e71a4a1692777188853097f685\">glomerular</span> <span class=\"customMeta\" data-dictid=\"83d76f27051692777202029aee0cd3\">filtration</span> and <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> secretion.</li>\n<li>Correction for PAH <span class=\"customMeta\" data-dictid=\"00456bf7d8169277718782edf9fa2c\">extraction</span> ratio improves accuracy.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most common complication following ligation of the first vessel during abdominoperineal resection for rectal carcinoma?", "options": [{"label": "A", "text": "Parasympathetic - bladder dysfunction and retrograde ejaculation", "correct": false}, {"label": "B", "text": "Sympathetic - bladder dysfunction and impotence", "correct": false}, {"label": "C", "text": "Sympathetic - retrograde ejaculation and bladder dysfunction", "correct": true}, {"label": "D", "text": "Sympathetic - impotence and loss of cutaneous sensation in the perineal region", "correct": false}], "correct_answer": "C. Sympathetic - retrograde ejaculation and bladder dysfunction", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which statement is accurate about the nerve action potential curve provided?", "options": [{"label": "A", "text": "The threshold point is at A", "correct": false}, {"label": "B", "text": "At point E, the nerve is more excitable", "correct": false}, {"label": "C", "text": "Point C to D is due to the opening of Na + and closure of K + channels", "correct": false}, {"label": "D", "text": "Point B to D is a refractory period", "correct": true}], "correct_answer": "D. Point B to D is a refractory period", "question_images": ["https://image.prepladder.com/notes/KeELmE7lhVHM5aVbtyj51745906238.png"], "explanation_images": ["https://image.prepladder.com/notes/KeELmE7lhVHM5aVbtyj51745906238.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Phase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Membrane Potential</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Na<sup>+</sup> Channels</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>K<sup>+</sup> Channels</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Resting State- Point A </strong><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Polarized (-70 mV)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Closed</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Closed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Depolarization (Rising Phase) </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less negative, towards 0 mV</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rapidly opening, then inactivating</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Slowly opens</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Overshoot (Peak)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Briefly positive (+35 mV)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inactivated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Open</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Repolarization (Falling Phase)- Point C to D </strong><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Returning to negative</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inactivated</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Open</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>After-hyperpolarization</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More negative</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Closed</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Slowly closing</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Return to Resting State- Point E </strong><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Returning to -70 mV</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Closed</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Closed</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 5-year-old child was brought with bony deformities, as shown in the radiograph below. These could be due to a deficiency of which of the following?", "options": [{"label": "A", "text": "Vitamin A", "correct": false}, {"label": "B", "text": "Vitamin D", "correct": true}, {"label": "C", "text": "Vitamin K", "correct": false}, {"label": "D", "text": "Vitamin C", "correct": false}], "correct_answer": "B. Vitamin D", "question_images": ["https://image.prepladder.com/content/3d1FDPZwg0gMvl9bEOIt1745298987.png"], "explanation_images": ["https://image.prepladder.com/content/9Dt9avvWFe9ofl69pfMx1745299031.png", "https://image.prepladder.com/content/sGDaJtKVrjEDCM7Ootrq1745299031.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Bone disorder characterized by failure of normal mineralisation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Vitamin D deficiency: Decreased intake, <span class=\"customMeta\" data-dictid=\"819ebcc6691692777191f968d41a03\">malabsorption</span> syndromes</li>\n<li>Impaired Vitamin D metabolism: Hepatic and Renal causes</li>\n<li>Defective Phosphates absorption:\n\t\t\t\t<ul>\n<li><strong>Hypophosphataemic Rickets (X-linked dominant)</strong></li>\n<li>Fanconi syndrome</li>\n<li>Renal <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> acidosis</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Craniotabes:</strong> pin-pong ball sensation of skull bone</li>\n<li><strong>Rachitic rosary:</strong> Painless <span class=\"customMeta\" data-dictid=\"ebc4d593fd1692777196b50a4faad4\">prominence</span> of <span class=\"customMeta\" data-dictid=\"bfa9e996381692777185cdc8709772\">costochondral</span> junctions</li>\n<li><strong>Harrison sulcus:</strong> <span class=\"customMeta\" data-dictid=\"6f4a4d02ec169277718995b05c1d26\">horizontal</span> depression on the lower part of chest</li>\n<li>Pigeon chest: Prominent sternum</li>\n<li>Deformities: Knock knees, bow legs</li>\n<li>Muscular hypotonia</li>\n<li>Delayed <span class=\"customMeta\" data-dictid=\"17dfb015d2169277720023db8fe9e5\">teeth</span> eruption</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Radiographic features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Delayed appearance of epiphysis</li>\n<li>Widening of <span class=\"customMeta\" data-dictid=\"dc486020a916927771874098596bbc\">epiphyseal</span> plates</li>\n<li>Cupping of metaphysis</li>\n<li>Splaying: <span class=\"customMeta\" data-dictid=\"863f5457381692777190f05632a8b2\">irregular</span> ends of metaphyseal plates</li>\n<li>Refraction of <span class=\"customMeta\" data-dictid=\"3a5e357f5b1692777186ef94b008d8\">diaphyseal</span> cortex</li>\n<li>Deformities: Genu varum, Genu valgum, Windswept <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">deformity</span> (Genu varum + valgum)</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Shankar Prasad Yadav\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/ray-showing-metaphyseal-widening-cupping-fraying-and-splaying_fig2_291336461\" data-tags=\"\" height=\"404\" src=\"https://image.prepladder.com/content/sGDaJtKVrjEDCM7Ootrq1745299031.png\" width=\"519\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Medical: Vitamin D supplementation 6 Lakh IU single dose followed by 400 IU daily.</li>\n<li>Non-operative: Splints, <span class=\"customMeta\" data-dictid=\"2a73ca8f1b16927771949cec7c59cc\">orthopaedic</span> shoes</li>\n<li>Surgical: Corrective osteotomies &gt; 6 months of age</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the type of transport across the cell membrane given below.", "options": [{"label": "A", "text": "Simple diffusion", "correct": false}, {"label": "B", "text": "Facilitated diffusion", "correct": true}, {"label": "C", "text": "Primary active transport", "correct": false}, {"label": "D", "text": "Secondary active transport", "correct": false}], "correct_answer": "B. Facilitated diffusion", "question_images": ["https://image.prepladder.com/notes/NMbsAsLfFAlA7kvcU6Kz1745906237.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Simple <span class=\"customMeta\" data-dictid=\"9c760dcb641692777186f4cda5dc95\">diffusion</span> </strong><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Facilitated <span class=\"customMeta\" data-dictid=\"9c760dcb641692777186f4cda5dc95\">diffusion</span> </strong><strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Move from high to low <span class=\"customMeta\" data-dictid=\"6fe354b91616927771982cc53f71fc\">solute</span> concentration (downhill transport)</li>\n<li>It does not require energy.</li>\n<li>Not require carrier protein (channel protein may or may not be present)</li>\n<li>No saturation: more concentration leads to a higher rate of transport.</li>\n<li>Fick's law: Rate (J) = D.A.∆C/x\n\t\t\t\t<ul>\n<li>D: <span class=\"customMeta\" data-dictid=\"9c760dcb641692777186f4cda5dc95\">Diffusion</span> constant.</li>\n<li>A: Surface area of diffusion.</li>\n<li>X: Thickness of the membrane.</li>\n<li>∆C: Concentration difference between membranes (most important determinant).</li>\n</ul>\n</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Movement of molecules across a <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> via carrier protein.</li>\n<li>No expenditure of energy.</li>\n<li>For example, <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> is transported by all types of GLUT.</li>\n<li>Saturation is achieved after a certain point called the plateau.</li>\n<li>The maximum transport rate occurs at the <span class=\"customMeta\" data-dictid=\"7a4ced7da71692777195938424f299\">plateau</span> or <span class=\"customMeta\" data-dictid=\"e4696a0f8d169277719865588e55c7\">saturation</span> point, called maximum (Tm).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents to the clinic with a lesion as shown in the image. He had a traumatic injury to the chest one year ago, and the scar has grown beyond the boundary of the initial injury. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Hemangioma", "correct": false}, {"label": "B", "text": "Hypertrophic scar", "correct": false}, {"label": "C", "text": "Keloid", "correct": true}, {"label": "D", "text": "Neurofibroma", "correct": false}], "correct_answer": "C. Keloid", "question_images": ["https://image.prepladder.com/content/4Sp5WB5eVKPAXic42DxO1745299201.png"], "explanation_images": ["https://image.prepladder.com/content/VpKVKHRdOfJSENtowiyu1745299249.png", "https://image.prepladder.com/content/bhxi62PdXzQUDlqmCN7Y1745299249.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old male presents with right thigh pain after undergoing bilateral laparoscopic hernia repair for an inguinal hernia. Which nerve entrapment is most likely responsible for this symptom?", "options": [{"label": "A", "text": "Ilioinguinal nerve", "correct": false}, {"label": "B", "text": "Iliohypogastric nerve", "correct": false}, {"label": "C", "text": "Femoral nerve", "correct": false}, {"label": "D", "text": "Lateral cutaneous nerve of thigh", "correct": true}], "correct_answer": "D. Lateral cutaneous nerve of thigh", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Triangle of Doom</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Triangle of Pain</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Boundaries:</strong></p>\n<ul>\n<li><strong>Medial:</strong> <span class=\"customMeta\" data-dictid=\"4e612482cf1692777201e5b0ae20f6\">Vas</span> deferens</li>\n<li><strong>Lateral:</strong> Gonadal vessels</li>\n<li><strong>Base:</strong> Fold of peritoneum</li>\n<li><strong>Apex:</strong> Deep inguinal ring</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Boundaries:</strong></p>\n<ul>\n<li><strong>Medial:</strong> Gonadal vessels</li>\n<li><strong>Lateral: </strong>Fold of peritoneum</li>\n<li><strong>Superior:</strong> <span class=\"customMeta\" data-dictid=\"e0b3e69ab9169277718997e696a3ab\">Iliopubic</span> tract</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Content</strong>:</p>\n<p>Iliac vessels are located behind the peritoneal fold.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Content</strong>:<strong> </strong>(Medial to Lateral)</p>\n<ul>\n<li>Femoral nerve</li>\n<li>Femoral branch of the <span class=\"customMeta\" data-dictid=\"65280a763b1692777188eb28595e8b\">genitofemoral</span> nerve</li>\n<li>Anterior <span class=\"customMeta\" data-dictid=\"94f1c8df1f1692777185bd6a7c3fff\">cutaneous</span> nerve of the thigh</li>\n<li>Lateral <span class=\"customMeta\" data-dictid=\"94f1c8df1f1692777185bd6a7c3fff\">cutaneous</span> nerve of the thigh</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Significance</strong>:</p>\n<p>Sharp <span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\">dissection</span> in this area risks damaging the <span class=\"customMeta\" data-dictid=\"837bfc230c16927771892ece07f94b\">iliac</span> vessels, which can lead to severe <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> and potentially life-threatening complications</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Significance</strong>:</p>\n<ul>\n<li>Potential risk of nerve damage if <span class=\"customMeta\" data-dictid=\"d4991429ac169277718750e171fb86\">electrocautery</span> is used.</li>\n<li><strong>The <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"94f1c8df1f1692777185bd6a7c3fff\">cutaneous</span> nerve of the thigh</strong> is the<strong> most commonly injured nerve.</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A preterm baby who was delivered at 28 weeks developed respiratory distress syndrome. Which of the following is true about surface tension and compliance in this baby?", "options": [{"label": "A", "text": "Surface tension - decreased; Compliance - increased", "correct": false}, {"label": "B", "text": "Surface tension - increased; Compliance decreased", "correct": true}, {"label": "C", "text": "Both surface tension and compliance decreased", "correct": false}, {"label": "D", "text": "Both surface tension and compliance increased", "correct": false}], "correct_answer": "B. Surface tension - increased; Compliance decreased", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the Glasgow Coma Scale (GCS) score of a patient who was admitted to the emergency room after being involved in a road traffic accident and, on examination, opens his eyes in response to a painful stimulus, speaks inappropriately, and withdraws his limbs in response to a painful stimulus?", "options": [{"label": "A", "text": "E2V2M3", "correct": false}, {"label": "B", "text": "E3V3M3", "correct": false}, {"label": "C", "text": "E2V3M4", "correct": true}, {"label": "D", "text": "E3V2M2", "correct": false}], "correct_answer": "C. E2V3M4", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:426px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Response</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Score</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Eye Opening (E)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Spontaneous</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>To speech</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>To pain</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"5\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Verbal Response (V)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Oriented</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Confused conversation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inappropriate words</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Incomprehensible sounds</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"6\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Motor Response (M)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Obeys commands</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Localizes to pain</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Withdraws from pain</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Abnormal <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> (decorticate)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Abnormal extension (decerebrate)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No response</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Head Injury Severity: Clinical Classification</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Minor head injury</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>GCS 15 with no LOC (loss of consciousness)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mild head injury</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>GCS 14 or 15 with LOC</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Moderate head injury</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>GCS 9 - 13</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Severe head injury</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>GCS 3 - 8</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:297px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Pupils Unreactive to Light</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Pupil <span class=\"customMeta\" data-dictid=\"d4b70f945316927771972d75389cf0\">Reactivity</span> Score</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Both Pupils</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>One Pupil</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Neither Pupil</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>0</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with fever, abdominal pain, and jaundice. Investigations show the given findings. Which of the following statements is true regarding this condition?", "options": [{"label": "A", "text": "Surgery is mandatory", "correct": false}, {"label": "B", "text": "Fine-needle aspiration cytology is diagnostic", "correct": false}, {"label": "C", "text": "Angioembolization is the treatment of choice", "correct": false}, {"label": "D", "text": "Echinococcus species is involved in etiology", "correct": true}], "correct_answer": "D. Echinococcus species is involved in etiology", "question_images": ["https://image.prepladder.com/notes/jKsBpVWDp7r5YlD0fRtp1745916341.png"], "explanation_images": ["https://image.prepladder.com/notes/WNOWUZXmpG0CBPwDTkNr1745916342.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient came to the hospital after a road traffic accident. He had severe muscle injury, and his serum K + level was found to be 6.5 mEq/L. What will happen to the resting membrane potential in this patient?", "options": [{"label": "A", "text": "No change", "correct": false}, {"label": "B", "text": "Becomes more negative", "correct": false}, {"label": "C", "text": "Becomes more positive", "correct": true}, {"label": "D", "text": "First becomes more positive then negative", "correct": false}], "correct_answer": "C. Becomes more positive", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/QXEvAr8q3w6j0idUDOh21745299737.png", "https://image.prepladder.com/content/AYTQq11lUCMclvINBFVI1745299747.png", "https://image.prepladder.com/content/Tic0OpiLyz7MjochxBeN1745299754.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Hyperkalemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Hypokalemia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>RMP</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Depolarized (Decreased RMP)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hyperpolarized (Increased RMP)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Explanation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Increased <span class=\"customMeta\" data-dictid=\"ba366417791692777187229d34e597\">extracellular</span> <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> reduces the <span class=\"customMeta\" data-dictid=\"04136f692516927771888cf07d46a4\">gradient</span> for <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> to exit the cell, causing depolarization.</li>\n<li>The resting <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> potential becomes less negative than the typical -70 mV. <strong>(Option C) </strong><strong>(Options A &amp; D ruled out)</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>In hypokalemia, cells lose more <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> ions due to leaky channels.</li>\n<li>The loss of positive charge increases the negative charge within the cell, causing hyperpolarization. <strong>(Option B ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Effect on Neuron Excitability</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Increased <span class=\"customMeta\" data-dictid=\"3892cfe03616927771872f834cf855\">excitability</span> can lead to <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">spontaneous</span> <span class=\"customMeta\" data-dictid=\"0c2d898b0b1692777202c5d43d5e78\">firing</span> and even cell death.</li>\n<li>Persistent <span class=\"customMeta\" data-dictid=\"dbaf58dd301692777186f2a8d7b3a0\">depolarization</span> inactivates voltage-gated sodium channels, preventing <span class=\"customMeta\" data-dictid=\"1313ac90ca16927771807502911c57\">action potential</span> generation.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Decreased <span class=\"customMeta\" data-dictid=\"3892cfe03616927771872f834cf855\">excitability</span> occurs as the <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> potential is further from the threshold for action potential.</li>\n<li>Hypokalemia also inhibits the Na-K-ATPase pump.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old alcoholic patient presents with sudden and unintentional weight loss. Lab investigations revealed serum alkaline phosphatase (ALP) of 240 IU/L, alpha-fetoprotein (AFP) of 600 ng/ml, and normal serum AST and ALT levels. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Hepatic adenoma", "correct": false}, {"label": "B", "text": "Cholangiocarcinoma", "correct": false}, {"label": "C", "text": "Hepatocellular carcinoma", "correct": true}, {"label": "D", "text": "Alcoholic hepatitis", "correct": false}], "correct_answer": "C. Hepatocellular carcinoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/bhWDk3aQowl5I6Zl5rbY1745299917.png", "https://image.prepladder.com/content/OHSUU91g9qh5ukCt9dT61745299917.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:667px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Cirrhosis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Metabolic disorders</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Environmental factors</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>HBV infection</li>\n<li>HCV infection</li>\n<li>Alcohol</li>\n<li>NAFLD</li>\n<li>Primary <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> cirrhosis</li>\n<li>Chronic active hepatitis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hemochromatosis</li>\n<li>Wilson's Disease</li>\n<li>Glycogen Storage Disorder</li>\n<li>α1AT-deficiency</li>\n<li>Porphyria cutanea tarda</li>\n<li>Citrullinemia</li>\n<li>Orotic aciduria</li>\n<li>Alagille's syndrome</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Cigarette Smoking</li>\n<li>Anabolic steroids</li>\n<li>Aflatoxin</li>\n<li>Thorotrast</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following zymogens requires gamma-glutamyl carboxylase?", "options": [{"label": "A", "text": "Factors II, VIII, IX, X", "correct": false}, {"label": "B", "text": "Factors II, VII, IX, and X", "correct": true}, {"label": "C", "text": "Factors II, VII, IX, XI", "correct": false}, {"label": "D", "text": "Factors II, VIII, X, XI", "correct": false}], "correct_answer": "B. Factors II, VII, IX, and X", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:456px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Factors </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Names </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fibrinogen</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Prothrombin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tissue thromboplastin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ca2+</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>V</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Labile factor</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>VII</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Stable factor</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>VIII</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Antihemophilic factor A</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>IX</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Christmas factor (Antihemophilic factor B)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>X</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Stuart-Prower factor</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>XI</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Plasma <span class=\"customMeta\" data-dictid=\"9b51982d06169277720063c9420fbb\">thromboplastin</span> <span class=\"customMeta\" data-dictid=\"401e45366416927771815b9706c778\">antecedent</span> (PTA)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>XII</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hageman factor</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>XIII</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fibrin stabilizing factor</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with features of chronic pancreatitis, including recurrent attacks, and has a 10 mm dilatation of the pancreatic duct with intraductal calculi present. Which of the following is the surgery of choice?", "options": [{"label": "A", "text": "Pancreaticoduodenectomy", "correct": false}, {"label": "B", "text": "Longitudinal pancreaticojejunostomy", "correct": true}, {"label": "C", "text": "ERCP and sphincterotomy", "correct": false}, {"label": "D", "text": "Coring of the pancreas head", "correct": false}], "correct_answer": "B. Longitudinal pancreaticojejunostomy", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented with diarrhea, dermatitis, and dementia. Which of the following vitamin deficiencies would you suspect in this patient?", "options": [{"label": "A", "text": "Vitamin B3 deficiency", "correct": true}, {"label": "B", "text": "Vitamin B1 deficiency", "correct": false}, {"label": "C", "text": "Vitamin B6 deficiency", "correct": false}, {"label": "D", "text": "Vitamin B12 deficiency", "correct": false}], "correct_answer": "A. Vitamin B3 deficiency", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/e39wk8sSRAJ9FsxStTFh1745906631.jpg"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What findings would be observed in a patient who has suffered a cervical spine injury due to a road traffic accident, whereby the fracture fragment has penetrated the lateral aspect of the dorsal column tract?", "options": [{"label": "A", "text": "Absence of ipsilateral lower limb proprioception", "correct": false}, {"label": "B", "text": "Absence of fine motor movement of fingers", "correct": false}, {"label": "C", "text": "Absence of ipsilateral arm proprioception", "correct": true}, {"label": "D", "text": "Absence of contralateral lower limb proprioception", "correct": false}], "correct_answer": "C. Absence of ipsilateral arm proprioception", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ARIChZg0lIqp3C6yiaO81745300041.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Pathway</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Sensory Modalities</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dorsal Column-Medial Lemniscal System</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Touch: Provides precise <span class=\"customMeta\" data-dictid=\"e485bb67f81692777191dfee6366cc\">localization</span> and fine gradations of intensity.</li>\n<li>Vibration: Detects rapid changes in stimulus through phasic sensations.</li>\n<li>Proprioception: Contributes to the sense of body position and movement.</li>\n<li>Pressure: Allows for the perception of fine degrees of pressure intensity.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Pathway</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Sensory receptors → <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">Spinal</span> cord (dorsal roots) → Brain (somatosensory cortex)</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Neurons</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>First-order neurons</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Originate in mechanoreceptors, and enter <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord via <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">dorsal</span> roots</li>\n<li>Pseudo-unipolar neurons with cell bodies in the <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">dorsal</span> root ganglion</li>\n<li>Split into <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> and <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> branches:\n\t\t\t\t<ul>\n<li>Medial branch: Travels up <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">dorsal</span> column to brain</li>\n<li>Lateral branch: Synapses in <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">dorsal</span> horn, forming local reflexes, <span class=\"customMeta\" data-dictid=\"1b023a99c41692777199f0afcc23f6\">spinocerebellar</span> tracts</li>\n</ul>\n</li>\n<li>Fibers from lower thoracic, sacral, and <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">lumbar</span> regions (T7-T12, L, S) ascend to <span class=\"customMeta\" data-dictid=\"53abb386551692777192c4d1f1f5ed\">medulla</span> without synapsing, forming the <span class=\"customMeta\" data-dictid=\"6f06ed0fab169277720273078a8258\">fasciculus</span> gracilis</li>\n<li>Fibers from <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> and upper <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> regions (C, T1-T6) ascend to <span class=\"customMeta\" data-dictid=\"53abb386551692777192c4d1f1f5ed\">medulla</span> without synapsing, forming the <span class=\"customMeta\" data-dictid=\"6f06ed0fab169277720273078a8258\">fasciculus</span> cuneatus <strong>(Option C)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Second-order neurons</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Synapse in <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">dorsal</span> <span class=\"customMeta\" data-dictid=\"53abb386551692777192c4d1f1f5ed\">medulla</span> (cuneate <span class=\"customMeta\" data-dictid=\"ff628904401692777193c8a9f9159e\">nucleus</span> for upper body, <span class=\"customMeta\" data-dictid=\"776c5be31e1692777188c8916fba20\">gracile</span> <span class=\"customMeta\" data-dictid=\"ff628904401692777193c8a9f9159e\">nucleus</span> for lower body)</li>\n<li>Cross to opposite <span class=\"customMeta\" data-dictid=\"2fd6b3cdf516927771836603ca8c63\">brain stem</span> side, travel to <span class=\"customMeta\" data-dictid=\"0c5f024f21169277720046ac004a34\">thalamus</span> (medial lemniscus)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Third-order neurons</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<ul>\n<li>Synapse in <span class=\"customMeta\" data-dictid=\"0c5f024f21169277720046ac004a34\">thalamus</span> (ventrobasal complex)</li>\n<li>Project to <span class=\"customMeta\" data-dictid=\"be46da176016927771984a269a5b2c\">somatosensory</span> <span class=\"customMeta\" data-dictid=\"cab8787ce916927771852a7e72f34d\">cortex</span> (postcentral gyrus, <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"51df38de3d1692777194ced4c4bab5\">parietal</span> cortex)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young boy presents to the OPD with hypoglycemia and muscle cramps, on exertion or while playing. Then he becomes normal after resting for a while. These episodes are recurrent after a period of activity. He has decreased serum lactate and glucose levels. Which of the following diseases is he most likely to be suffering from?", "options": [{"label": "A", "text": "McArdle disease", "correct": true}, {"label": "B", "text": "Hers disease", "correct": false}, {"label": "C", "text": "Cori's disease", "correct": false}, {"label": "D", "text": "Andersen disease", "correct": false}], "correct_answer": "A. McArdle disease", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:509px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>GSD Type</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>GSD with Hypoglycemia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>0 (0a, 0b)</li>\n<li>I (Ia, Ib) -Von Gierke Disease<strong> </strong></li>\n<li>III - Cori Disease</li>\n<li>VI - Hers Disease</li>\n<li>IX (IXa, IXb, IXc, IXd)</li>\n<li>XI - Fanconi-Bickel Syndrome</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>GSD with Exercise Intolerance</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>III - Cori Disease</li>\n<li>V - McArdle Disease</li>\n<li>VII - Tarui Disease</li>\n<li>XII</li>\n<li>XIII</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Both</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>III - Cori Disease</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Neither</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>IV - Andersen’s Disease<strong> </strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A woman presents with a BIRADS-5 breast lesion. Which of the following is a good prognostic factor for this lesion?", "options": [{"label": "A", "text": "BRCA-1 positive", "correct": false}, {"label": "B", "text": "p53 positive", "correct": false}, {"label": "C", "text": "ER positive", "correct": true}, {"label": "D", "text": "High Ki-67", "correct": false}], "correct_answer": "C. ER positive", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:649px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Disease factors that influence prognosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Histologic Subtypes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Invasive Ductal <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">Carcinoma</span> (IDC): <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">Prognosis</span> varies by <span class=\"customMeta\" data-dictid=\"d4ae50897e16927771884b5c46ba7d\">grade</span> and molecular markers.</li>\n<li>Invasive Lobular <span class=\"customMeta\" data-dictid=\"988c19e3131692777183b6744d1920\">Carcinoma</span> (ILC): <span class=\"customMeta\" data-dictid=\"cf8f491dba169277719075ce2b5594\">Intermediate</span> prognosis.</li>\n<li>Tubular and <span class=\"customMeta\" data-dictid=\"2f72b35d711692777193801d8e084d\">Mucinous</span> Carcinomas: Best prognosis.</li>\n<li>Basal-like Breast Cancer: Aggressive, triple-negative, no targeted treatments.</li>\n<li>Other Subtypes: Medullary, cribriform, papillary, <span class=\"customMeta\" data-dictid=\"11fd4461491692777180591f35947b\">adenoid</span> cystic, and <span class=\"customMeta\" data-dictid=\"03f835a65f169277719239326cc094\">metaplastic</span> carcinomas vary in prognosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tumor Size &amp; <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">Lymph</span> Node</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pathologic <span class=\"customMeta\" data-dictid=\"8ea2e3870f16927771990a138acbc1\">staging</span> (tumour size, <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes) guides <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> and treatment.</li>\n<li>Larger tumours and positive <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> nodes = worse prognosis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Molecular Markers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Hormone Receptors (ER, PR)</strong>:</li>\n<li><strong>ER-positive = better prognosis</strong>, responsive to <span class=\"customMeta\" data-dictid=\"d8216cf7571692777187baa94b8612\">endocrine</span> therapy.</li>\n<li><strong>HER-2 Status:</strong> HER-2 positive = aggressive but treatable with targeted therapies.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Patient factors that influence prognosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Younger, particularly <span class=\"customMeta\" data-dictid=\"a9f4834def16927771962441e4ed98\">premenopausal</span> women, may have higher local <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> rates post-surgery, but radiation therapy can reduce this risk.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>BRCA Mutation</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Generally more aggressive and associated with poorer prognosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Family History</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A strong family history may indicate inherited <span class=\"customMeta\" data-dictid=\"6ced8252211692777199ab0cc3f2bb\">susceptibility</span> and potentially a worse prognosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prior Breast Cancer History</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Previous breast cancer can negatively influence the <span class=\"customMeta\" data-dictid=\"e580b4033e169277719609af594c16\">prognosis</span> of a new diagnosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lifestyle Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Obesity and <span class=\"customMeta\" data-dictid=\"66aad2dcdb169277719098b25eec8c\">inactivity</span> are <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to increased <span class=\"customMeta\" data-dictid=\"1d849ebc9b1692777197d4af1fa8d2\">recurrence</span> risk and may affect overall prognosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment Adherence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Non-compliance can worsen prognosis.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the true statement regarding the segment marked in red on the myocardial action potential curve?", "options": [{"label": "A", "text": "Due to opening of Na + and closure of fast K + channels", "correct": false}, {"label": "B", "text": "Due to slow but prolonged opening of Ca 2+ channels", "correct": true}, {"label": "C", "text": "Due to closure of Na + and opening of slow K + channels", "correct": false}, {"label": "D", "text": "Due to Na + /K + ATPase", "correct": false}], "correct_answer": "B. Due to slow but prolonged opening of Ca 2+ channels", "question_images": ["https://image.prepladder.com/notes/Dwzb2HKmd9pavC6zbnU61745906237.png"], "explanation_images": ["https://image.prepladder.com/content/ALXgpNFWVO1SC73mp2ZQ1745300397.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Phases</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Opening and <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">Closure</span> of Channels</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Phase 0- Depolarization</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Opening of voltage-gated Na<sup>+</sup> channels</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Phase 1- Initial rapid <span class=\"customMeta\" data-dictid=\"40451a27bd1692777197d6c276d0bc\">repolarization</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Closure of Na<sup>+</sup> channels</p>\n<p>Opening of K<sup>+</sup> channel (<strong>option C</strong>)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Phase 2- <span class=\"customMeta\" data-dictid=\"7a4ced7da71692777195938424f299\">Plateau</span> phase </strong><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Slower but prolonged opening of L-type voltage-gated Ca<sup>2+</sup> channels</p>\n<p>K<sup>+</sup> channel also remains open.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Phase 3- Late rapid repolarization</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Closure of the Ca<sup>2+</sup> channels</p>\n<p>Slow, delayed increase of K<sup>+</sup> efflux</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Phase 4- Baseline</strong><strong> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Resting Membrane Potential About −80 to −90 millivolts.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with a sudden onset of chest pain shooting to the neck and interscapular region. X-ray shows a widened mediastinum. Blood pressure is 110/90 mmHg in the right upper limb and 160/100 mmHg in the left upper limb. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Acute coronary syndrome", "correct": false}, {"label": "B", "text": "Acute pulmonary embolism", "correct": false}, {"label": "C", "text": "Acute aortic dissection", "correct": true}, {"label": "D", "text": "Esophageal rupture", "correct": false}], "correct_answer": "C. Acute aortic dissection", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/D9Db9f2BTTwFXSfiTtCb1745300436.png", "https://image.prepladder.com/content/42Ndr6zXip20fNTvKvqZ1745300436.png", "https://image.prepladder.com/content/frvbVcXEBLDn4vIjPDDi1745300436.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>DeBakey Classification</strong></p>\n<p style=\"text-align:center\">(Based on the pattern of dissection)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type I </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Both <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> and <span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\">descending</span> <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> are involved</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type II </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Only the <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> is involved</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Only the <span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\">descending</span> <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> is involved</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Stanford <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">Classification</span> </strong></p>\n<p style=\"text-align:center\">(Based on whether the <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> is involved in aortic dissection)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type A </strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Only the <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> or both <span class=\"customMeta\" data-dictid=\"62f0d7c8491692777182ab7cc82edb\">ascending</span> and <span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\">descending</span> <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> is involved.</p>\n<p>(It includes both Type I and Type II of DeBakey’s classification)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type B</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Only the <span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\">descending</span> <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> is involved.</p>\n<p>(It includes Type III of DeBakey’s classification)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a 30-year-old male who has nonaxial proptosis in his left eye and a history of a road traffic accident 15 years ago, as suggested by the provided CT image?", "options": [{"label": "A", "text": "Frontal mucocele", "correct": true}, {"label": "B", "text": "Frontal meningioma", "correct": false}, {"label": "C", "text": "Juvenile nasopharyngeal angiofibroma", "correct": false}, {"label": "D", "text": "Pseudotumor of orbit", "correct": false}], "correct_answer": "A. Frontal mucocele", "question_images": ["https://image.prepladder.com/notes/7eFRRdaVEEyNbQ9F8z371745909543.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient arrives with pain in the right upper abdomen. One week ago, the patient experienced a bout of diarrhoea. Abdominal CT scan results indicate the presence of a liver abscess measuring approximately 25 cubic centimetres. What should be the subsequent course of action in treating this patient?", "options": [{"label": "A", "text": "PAIR", "correct": false}, {"label": "B", "text": "Surgery", "correct": false}, {"label": "C", "text": "Medical therapy", "correct": true}, {"label": "D", "text": "Percutaneous drainage", "correct": false}], "correct_answer": "C. Medical therapy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:604px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Amebic Abscess</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Pyogenic Abscess</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>20–40 years</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>&gt;50 years</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Male-to-Female Ratio</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>≥10:1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>1.5:1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Solitary vs Multiple</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Solitary 80%</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Solitary 50%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Usually right liver</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Usually right liver</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Travel in <span class=\"customMeta\" data-dictid=\"59c8c1e4b316927771873c98afae15\">Endemic</span> Area</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Yes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>No</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Diabetes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Uncommon (∼2%)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>More common (∼27%)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Alcohol Use</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Common</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Common</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Jaundice</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Uncommon</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Common</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Elevated Bilirubin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Uncommon</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Common</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Elevated <span class=\"customMeta\" data-dictid=\"b95c7f7b821692777181df660ee7ff\">Alkaline</span> Phosphatase</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Common</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Common</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Positive Blood Culture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>No</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Common</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Positive Amebic Serology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Yes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>No</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old patient presents with confusion and ataxia following trauma one week ago. He has a history of alcohol dependence, with his last intake 2 weeks ago. A CT scan reveals the following findings. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Extradural hemorrhage", "correct": false}, {"label": "B", "text": "Subdural hemorrhage", "correct": true}, {"label": "C", "text": "Intra-parenchymal hemorrhage", "correct": false}, {"label": "D", "text": "Subarachnoid hemorrhage", "correct": false}], "correct_answer": "B. Subdural hemorrhage", "question_images": ["https://image.prepladder.com/content/oG4C2OfvfINnr2qPbY171745300966.png"], "explanation_images": ["https://image.prepladder.com/content/DZOX4ylRQIu3V95RFbvG1745301006.png", "https://image.prepladder.com/content/oEj8A7xBV5stzKnW4Vhc1745301006.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:900px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Subdural Hematoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Extradural Hematoma</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Between <span class=\"customMeta\" data-dictid=\"826ce1571f1692777186a0b6e02559\">Dura</span> and Arachnoid</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Between <span class=\"customMeta\" data-dictid=\"826ce1571f1692777186a0b6e02559\">Dura</span> and Skull</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>CT Appearance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Crescent-shaped</strong></li>\n<li><strong>Crosses <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> lines</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Biconvex or lens-shaped </strong></li>\n<li>Well-defined &amp; Localized,</li>\n<li><strong>Won’t cross <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> lines</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tearing of <span class=\"customMeta\" data-dictid=\"ec4db08de51692777183e82739c83d\">bridging</span> veins</strong>, often due to <span class=\"customMeta\" data-dictid=\"324b1bfa7816927771834f9e3f6704\">blunt</span> trauma / acceleration-deceleration injuries</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Rupture of the middle meningeal <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> or vein</strong> due to skull <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> or trauma</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Develop over days to weeks; Acute SDH can occur rapidly</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Usually develop rapidly</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Craniotomy / Craniectomy</strong>, if significant.</li>\n<li>Conservative management for smaller, stable cases.</li>\n<li><strong>Burr hole <span class=\"customMeta\" data-dictid=\"dd824a31e71692777186c7f8168998\">drainage</span> </strong>is preferred for significant chronic cases</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Urgent <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> <span class=\"customMeta\" data-dictid=\"0705e4cf081692777187f4d2b512aa\">evacuation</span> for significant or deteriorating cases.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"James Heilman\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"Subduralandherniation - Subdural hematoma - Wikipedia\" data-tags=\"\" height=\"286\" src=\"https://image.prepladder.com/content/DZOX4ylRQIu3V95RFbvG1745301006.png\" width=\"261\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"James Heilman\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"EpiduralHematoma - Epidural hematoma - Wikipedia\" data-tags=\"\" height=\"286\" src=\"https://image.prepladder.com/content/oEj8A7xBV5stzKnW4Vhc1745301006.png\" width=\"231\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old patient comes with hoarseness of voice and difficulty swallowing. The patient was diagnosed with laryngeal carcinoma, and surgical management was done. The post-operative image of the patient is given below. Which of the following surgery was done on this patient?", "options": [{"label": "A", "text": "Partial laryngectomy", "correct": false}, {"label": "B", "text": "Percutaneous tracheostomy", "correct": false}, {"label": "C", "text": "Standard tracheostomy", "correct": false}, {"label": "D", "text": "Total laryngectomy", "correct": true}], "correct_answer": "D. Total laryngectomy", "question_images": ["https://image.prepladder.com/notes/yaTEqfvCu766x2sBRY4I1745909547.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In which of the following nerve injuries is the instrument shown below used?", "options": [{"label": "A", "text": "Radial nerve", "correct": true}, {"label": "B", "text": "Median nerve", "correct": false}, {"label": "C", "text": "Ulnar nerve", "correct": false}, {"label": "D", "text": "Volkmann's ischemic contracture", "correct": false}], "correct_answer": "A. Radial nerve", "question_images": ["https://image.prepladder.com/notes/hiTrXmTsOCOQQJpdgeDR1745912209.png"], "explanation_images": ["https://image.prepladder.com/notes/hiTrXmTsOCOQQJpdgeDR1745912209.png", "https://image.prepladder.com/notes/z8K8NabVbgVTMBCGNkUb1745912210.png", "https://image.prepladder.com/notes/GktND1ys8cnozQXrZn6V1745912211.png", "https://image.prepladder.com/notes/z8eEkHmqysb0TOVstyn81745912212.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type of Injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Treatment</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Open Injuries</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Immediate exploration and nerve repair or grafting</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Closed Injuries</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Wait 12 weeks for recovery before exploring</li>\n<li>Use EMG if no improvement; if <span class=\"customMeta\" data-dictid=\"c35382d7d61692777185a1eeeb333c\">denervation</span> is detected, perform nerve exploration and repair or grafting</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fractures of Humerus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Assess for nerve injury on admission</li>\n<li>If the injury appears post-manipulation or internal fixation, explore and repair or <span class=\"customMeta\" data-dictid=\"a283380a9a1692777188549537a964\">graft</span> immediately</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Recovery Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Perform <span class=\"customMeta\" data-dictid=\"c72d29ec4116927771942153c0d252\">passive</span> hand movements</li>\n<li>Splint the wrist in extension-cock up splint:\n\t\t\t\t<figure class=\"caption_element\"><img alt=\"POR064\" data-author=\"NA\" data-hash=\"11393\" data-license=\"NA\" data-source=\"NA\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/z8K8NabVbgVTMBCGNkUb1745912210.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Long-term Disability</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Tendon transfers: <span class=\"customMeta\" data-dictid=\"51d02ec7e5169277719693f472fa48\">pronator</span> <span class=\"customMeta\" data-dictid=\"8ad930500b1692777200545684a556\">teres</span> to short <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> extensor, <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">flexor</span> carpi <span class=\"customMeta\" data-dictid=\"282d33f842169277719716e285a377\">radialis</span> or <span class=\"customMeta\" data-dictid=\"d4cb28e3e91692777201b2085b4f79\">ulnaris</span> to finger extensors, <span class=\"customMeta\" data-dictid=\"2a7c79c3d01692777194c9e71d569b\">palmaris</span> <span class=\"customMeta\" data-dictid=\"7ff574b4f61692777191fa536b5e6c\">longus</span> to thumb abductor</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A family consumes only polished rice. Which of the following combinations of vitamin deficiency and enzymatic defect will be present in this family?", "options": [{"label": "A", "text": "Riboflavin-glutathione reductase", "correct": false}, {"label": "B", "text": "Thiamine-transketolase", "correct": true}, {"label": "C", "text": "Thiamine-transaminase", "correct": false}, {"label": "D", "text": "Riboflavin-transketolase", "correct": false}], "correct_answer": "B. Thiamine-transketolase", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/R4PxCvp4vYBVU8pnn8Oa1745906710.jpg"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>VITAMINS</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>ASSAYS TO DETECT DEFICIENCY</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Vitamin B1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Transketolase</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Vitamin B2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Glutathione reductase</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Vitamin B3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Xanthenuric acid/ Tryptophan load test</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Vitamin B6</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>FIGLU/ Histidine load test</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Vitamin B12</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Methyl malonate</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During the examination of a female patient with hearing loss, it was observed that she had a negative Rinne test result at frequencies of 256 Hz and 512 Hz, but a positive Rinne test result at 1024 Hz. What would be the anticipated gap between air conduction and bone conduction in this case?", "options": [{"label": "A", "text": "30-45 dB", "correct": false}, {"label": "B", "text": "15-30 dB", "correct": true}, {"label": "C", "text": "45-60 dB", "correct": false}, {"label": "D", "text": "&amp;gt;60 dB", "correct": false}], "correct_answer": "B. 15-30 dB", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The radiograph below depicts a patient who is experiencing persistent knee pain without any previous injury. Identify the specific condition displayed in the image?", "options": [{"label": "A", "text": "Patellar avulsion fracture, TBW", "correct": false}, {"label": "B", "text": "Bipartite patella, X-ray of the opposite knee", "correct": true}, {"label": "C", "text": "Fracture of the upper pole of the patella, Cylindrical cast", "correct": false}, {"label": "D", "text": "Avulsion fracture, interfragmentary screw fixation", "correct": false}], "correct_answer": "B. Bipartite patella, X-ray of the opposite knee", "question_images": ["https://image.prepladder.com/content/4CsgBuDRS3PPilrrxDZn1745301681.png"], "explanation_images": ["https://image.prepladder.com/content/DCOgcJ20zhWyAhni8vMs1745301724.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>A <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> condition where the <span class=\"customMeta\" data-dictid=\"615557ed3a169277719497f86e830b\">patella</span> (kneecap) is divided into two separate bone segments.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Failure of <span class=\"customMeta\" data-dictid=\"3be8c9fc131692777194e15d6aeef3\">ossification</span> centers to <span class=\"customMeta\" data-dictid=\"30bdb5481f1692777203cbadf50a71\">fuse</span> during development, resulting in separate bone fragments.</li>\n<li>Occurs in approximately 1-2% of the population, often bilateral.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Anatomy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Typically involves the <span class=\"customMeta\" data-dictid=\"372f8a661016927771993a9755d398\">superolateral</span> corner of the patella.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Based on the location of the secondary <span class=\"customMeta\" data-dictid=\"3be8c9fc131692777194e15d6aeef3\">ossification</span> centre,</p>\n<ul>\n<li>Type I: Inferior pole of patella.</li>\n<li>Type II: <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">Lateral</span> margin.</li>\n<li>Type III: <span class=\"customMeta\" data-dictid=\"372f8a661016927771993a9755d398\">Superolateral</span> (most common).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Usually asymptomatic, but can cause <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> knee pain, especially after trauma or repetitive stress.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>X-ray: Shows the <span class=\"customMeta\" data-dictid=\"615557ed3a169277719497f86e830b\">patella</span> with a well-corticated fragment.</p>\n<p>MRI: Useful for assessing associated soft tissue injury or bone <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> if symptomatic.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Differential Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Patellar <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> (differs by smooth, rounded edges in <span class=\"customMeta\" data-dictid=\"fbe4520a1316927771830df0903b72\">bipartite</span> <span class=\"customMeta\" data-dictid=\"615557ed3a169277719497f86e830b\">patella</span> vs sharp edges in fractures).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Asymptomatic: No treatment required.</li>\n<li>Symptomatic: Rest, NSAIDs, physical therapy, or in severe cases, surgery (excision of fragment).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the structure marked by the yellow arrow in the image.", "options": [{"label": "A", "text": "Fossa of Rosenmuller", "correct": true}, {"label": "B", "text": "Tubal tonsil", "correct": false}, {"label": "C", "text": "Opening of the Eustachian tube", "correct": false}, {"label": "D", "text": "Adenoid", "correct": false}], "correct_answer": "A. Fossa of Rosenmuller", "question_images": ["https://image.prepladder.com/notes/XpcNPqMF25wtclAd20h61745909708.png"], "explanation_images": ["https://image.prepladder.com/notes/wIsZYhSAUeOyitCIKmzt1745909776.jpg"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Below is an image of angiotensin II synthesis and neprilysin action with two arrows at ACE and Neprilysin. Which drug acts on both enzymes?", "options": [{"label": "A", "text": "Sacubitril", "correct": false}, {"label": "B", "text": "Omapatrilat", "correct": true}, {"label": "C", "text": "Losartan", "correct": false}, {"label": "D", "text": "Nesiritide", "correct": false}], "correct_answer": "B. Omapatrilat", "question_images": ["https://image.prepladder.com/notes/95M4fJNqeciBynK7lynN1745908351.png"], "explanation_images": ["https://image.prepladder.com/notes/pD5uXBMFun8FbnkPe7Lr1745908351.png"], "explanation": "<p>Correct Answer B - Omapatrilat </p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Omapatrilat</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"PPH006\" data-author=\"NA\" data-hash=\"11372\" data-license=\"NA\" data-source=\"NA\" data-tags=\"April2025\" height=\"260\" src=\"https://image.prepladder.com/notes/pD5uXBMFun8FbnkPe7Lr1745908351.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Uses</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Primarily for the treatment of <strong>hypertension</strong> and <strong>heart failure</strong><strong>.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Adverse Effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Angioedema</strong></li>\n<li>Hypotension</li>\n<li>Cough</li>\n<li>Dizziness</li>\n<li>Fatigue</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the orthopedics outpatient department, a female patient is presenting with difficulty sleeping at night due to experiencing numbness and tingling in the outer three digits of their hand. The symptoms improve when the patient hangs their arms from the bed. Which of the following choices accurately identifies the patient's condition and the test employed to evaluate it?", "options": [{"label": "A", "text": "Guyon's canal syndrome, Froment's test", "correct": false}, {"label": "B", "text": "Carpal tunnel syndrome, Froment's test", "correct": false}, {"label": "C", "text": "Guyon's canal syndrome, Durkan's test", "correct": false}, {"label": "D", "text": "Carpal tunnel syndrome, Durkan's test", "correct": true}], "correct_answer": "D. Carpal tunnel syndrome, Durkan's test", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/Hsk8uJjOI86y49MVa7hX1745912212.png", "https://image.prepladder.com/content/0bco0RrAyFPdZE1rdyt91745301885.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:621px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Compression of the <span class=\"customMeta\" data-dictid=\"979385c98a1692777192fb1721a16e\">median</span> nerve as it passes through the <span class=\"customMeta\" data-dictid=\"c8a21e01261692777183ccc5569251\">carpal</span> tunnel in the wrist</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Numbness, <span class=\"customMeta\" data-dictid=\"b7020a23961692777200b1237ae429\">tingling</span> in thumb, index, and middle fingers</li>\n<li>Pain in hand and wrist, Weakness in grip</li>\n<li>Symptoms often <strong>worse at night </strong>and improve during the day.</li>\n<li>Advanced cases may lead to hand weakness, clumsiness, and muscle atrophy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Structures Affected</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Median Nerve</strong>: Compressed within the <span class=\"customMeta\" data-dictid=\"c8a21e01261692777183ccc5569251\">carpal</span> tunnel, leading to symptoms and signs.</li>\n<li><strong>Flexor Tendons</strong>: The nine <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">flexor</span> tendons passing through the <span class=\"customMeta\" data-dictid=\"c8a21e01261692777183ccc5569251\">carpal</span> tunnel can become inflamed, further compressing the <span class=\"customMeta\" data-dictid=\"979385c98a1692777192fb1721a16e\">median</span> nerve.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Structures Spared</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Thenar Eminence</strong>: <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">Sensory</span> loss generally spares this area because its nerve (palmar <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> <span class=\"customMeta\" data-dictid=\"94f1c8df1f1692777185bd6a7c3fff\">cutaneous</span> nerve) bypasses the <span class=\"customMeta\" data-dictid=\"c8a21e01261692777183ccc5569251\">carpal</span> tunnel.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Signs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Weakness: </strong>Notable weakness in thumb <span class=\"customMeta\" data-dictid=\"69ae073b9f169277718021ae773099\">abduction</span> and opposition.</li>\n<li><strong>Atrophy</strong>: Possible <span class=\"customMeta\" data-dictid=\"97ff5253fb169277718224c7b0faf8\">atrophy</span> of the <span class=\"customMeta\" data-dictid=\"48c587f4c51692777200fe869f1699\">thenar</span> <span class=\"customMeta\" data-dictid=\"c7cd7c82631692777187abb016ed2e\">eminence</span> in advanced cases.</li>\n<li><strong>Sensory Loss</strong>: Loss typically affects the <span class=\"customMeta\" data-dictid=\"979385c98a1692777192fb1721a16e\">median</span> nerve distribution (thumb, index, middle, and <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> half of the fourth digit).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Idiopathic-</strong> commonest cause</li>\n<li><strong>Inflammatory causes- </strong>Rheumatoid arthritis, wrist osteoarthritis</li>\n<li><strong>Post-traumatic causes-</strong> Bone thickening after a Colles' fracture</li>\n<li><strong>Endocrine causes-</strong> Myxoedema, Acromegaly</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnostic Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Nerve Conduction Studies (NCS) - primary <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> test</li>\n<li>Electromyography (EMG)</li>\n<li><strong>Phalen Test:</strong> Positive if pain/paresthesias arise during wrist flexion.</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"LittleT889\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Phalen%27s_Maneuver.jpg\" data-tags=\"\" height=\"277\" src=\"https://image.prepladder.com/content/0bco0RrAyFPdZE1rdyt91745301885.png\" width=\"578\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<ul>\n<li><strong>Tinel Test:</strong> Positive if tapping over the <span class=\"customMeta\" data-dictid=\"c8a21e01261692777183ccc5569251\">carpal</span> tunnel elicits symptoms.</li>\n<li><strong>Durkan test:</strong> Direct <span class=\"customMeta\" data-dictid=\"56af81fad316927771843d2b4b1e4f\">compression</span> on <span class=\"customMeta\" data-dictid=\"979385c98a1692777192fb1721a16e\">Median</span> nerve for 30 seconds. <strong>More specific</strong> than the Phalen/Tinel test.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Conservative: Wrist splinting, NSAIDs, activity modification</li>\n<li>Corticosteroid injections</li>\n<li>Surgical: <span class=\"customMeta\" data-dictid=\"c8a21e01261692777183ccc5569251\">Carpal</span> tunnel release (for severe or <span class=\"customMeta\" data-dictid=\"3790c638ab16927771970a0a41d3ab\">refractory</span> cases)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What do chaperones assist in?", "options": [{"label": "A", "text": "Ubiquitinization of proteins", "correct": false}, {"label": "B", "text": "Protein modification", "correct": false}, {"label": "C", "text": "Protein folding", "correct": true}, {"label": "D", "text": "Protein cleavage", "correct": false}], "correct_answer": "C. Protein folding", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A bronchial asthma patient on inhalational steroids with white patchy lesions on the tongue and buccal mucosa. Which of the following drugs can be used to treat this condition?", "options": [{"label": "A", "text": "Clotrimazole", "correct": true}, {"label": "B", "text": "Griseofulvin", "correct": false}, {"label": "C", "text": "Terbinafine", "correct": false}, {"label": "D", "text": "Flucytosine", "correct": false}], "correct_answer": "A. Clotrimazole", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/ihJermivSMXZxy00otsz1745908353.png"], "explanation": "<p>Correct Answer A) C\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The instrument shown in the image is not used for which of the following?", "options": [{"label": "A", "text": "Airway toileting", "correct": false}, {"label": "B", "text": "Upper airway examination", "correct": true}, {"label": "C", "text": "Acute nasopharyngeal obstruction", "correct": false}, {"label": "D", "text": "Prolonged mechanical ventilation", "correct": false}], "correct_answer": "B. Upper airway examination", "question_images": ["https://image.prepladder.com/content/tzASRC1PoJSBW0zJ62VP1745301987.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is not true regarding the provided medical condition?", "options": [{"label": "A", "text": "Repeated radical surgery every 24 hours may be required to adequately manage this condition", "correct": false}, {"label": "B", "text": "This is a case of Meleney's gangrene", "correct": false}, {"label": "C", "text": "The condition is caused by β-hemolytic streptococcus and may sometimes be polymicrobial", "correct": false}, {"label": "D", "text": "Hyperbaric oxygen has no role in the treatment of this condition.", "correct": true}], "correct_answer": "D. Hyperbaric oxygen has no role in the treatment of this condition.", "question_images": ["https://image.prepladder.com/notes/IBD0eZHYvrInI3YX8Rox1745916344.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 4-year-old child presents with easy fatiguability. The mother also complains that the child has increased hunger between meals, which is relieved after food. Liver examination revealed no glycogen. The enzyme most likely deficient is", "options": [{"label": "A", "text": "Glycogen phosphorylase", "correct": false}, {"label": "B", "text": "Glycogen synthase", "correct": true}, {"label": "C", "text": "Debranching enzyme", "correct": false}, {"label": "D", "text": "Glucose 6 phosphatase", "correct": false}], "correct_answer": "B. Glycogen synthase", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:536px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Glycogen storage disease type 0 (0a and 0b)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Enzyme Deficiency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Glycogen <span class=\"customMeta\" data-dictid=\"d2bd91ccac169277719941254e1795\">synthase</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Affected Gene</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>GYS2 and GYS1</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hypoglycemia, Hyperketonemia, early death</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mode of Inheritance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Autosomal recessive</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Supportive care: Frequent protein-rich meals and <span class=\"customMeta\" data-dictid=\"d61e782bf41692777182f829eef312\">avoidance</span> of fasting. <span class=\"customMeta\" data-dictid=\"942d5b969b1692777185c1c820009c\">Cornstarch</span> may be given nighttime</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:631px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Glycogen Storage Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Enzyme Deficiency</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Type 0</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Glycogen <span class=\"customMeta\" data-dictid=\"d2bd91ccac169277719941254e1795\">synthase</span> deficiency</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Type I (von Gierke's Disease)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Glucose-6-phosphatase <strong> (Option D ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Type II (Pompe's Disease)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Acid α-glucosidase (acid maltase)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Type III (Cori's Disease)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Debranching <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> (amylo-1,6-glucosidase)<strong> (Option C ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Type IV (Andersen's Disease)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Branching enzyme</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Type V (McArdle's Disease)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Muscle <span class=\"customMeta\" data-dictid=\"1fa65725491692777195ead6a7c81b\">phosphorylase</span> (myophosphorylase) <strong> (Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Type VI (Hers' Disease)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Liver phosphorylase</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Type VII (Tarui's Disease)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Phosphofructokinase (muscle type)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a 10-year-old child with symptoms of throat pain, fever, and ear pain, the diagnosis is recurrent tonsillitis. Which specific nerve is associated with the ear pain in this patient?", "options": [{"label": "A", "text": "Tympanic branch of the glossopharyngeal nerve", "correct": true}, {"label": "B", "text": "Greater auricular nerve", "correct": false}, {"label": "C", "text": "Auriculotemporal nerve", "correct": false}, {"label": "D", "text": "Auricular branch of the vagus nerve", "correct": false}], "correct_answer": "A. Tympanic branch of the glossopharyngeal nerve", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child was brought with pedal edema and cheilosis.Cardiomegaly was present. What is the vitamin deficiency associated with this clinical presentation?", "options": [{"label": "A", "text": "Riboflavin", "correct": false}, {"label": "B", "text": "Thiamine", "correct": true}, {"label": "C", "text": "Pyridoxine", "correct": false}, {"label": "D", "text": "Niacin", "correct": false}], "correct_answer": "B. Thiamine", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:629px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Conditions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Biochemical Role of Thiamine</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Deficiency Manifestations</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Dry Beriberi</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Essential for carbohydrate <span class=\"customMeta\" data-dictid=\"5b1a045f5f169277719210c0ac7a1e\">metabolism</span> and nerve function</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>CNS manifestations such as <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> neuritis, <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> disturbances, difficulty walking, and <span class=\"customMeta\" data-dictid=\"72fa9105b916927771945aef35e8ed\">paralysis</span> due to <span class=\"customMeta\" data-dictid=\"e1a4a12fb416927771841c46faf6fb\">CNS</span> manifestations.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Wet Beriberi</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Thiamine is necessary for the PDH complex and low activity causes <span class=\"customMeta\" data-dictid=\"b82539c9ae1692777191a3f7ddd7bb\">Lactic</span> acidosis. <span class=\"customMeta\" data-dictid=\"b82539c9ae1692777191a3f7ddd7bb\">Lactic</span> <span class=\"customMeta\" data-dictid=\"6caf3a39f416927771807e122b9032\">acidosis</span> causes <span class=\"customMeta\" data-dictid=\"5a54975e76169277720193e665d9ad\">vasodilatation</span> and hence <span class=\"customMeta\" data-dictid=\"e2b5f013011692777183ea1b11ed9c\">cardiovascular</span> manifestations.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Cardiovascular manifestations such as oedema, palpitations, breathlessness, and heart failure.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Maple <span class=\"customMeta\" data-dictid=\"7cab9109cd16927771994c3125bd23\">Syrup</span> <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">Urine</span> Disease</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Cofactor for <span class=\"customMeta\" data-dictid=\"52adc3ebf01692777185395a8b1e8c\">decarboxylation</span> of branched-chain keto acids</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Accumulation of branched-chain keto acids leads to convulsions, severe mental retardation, vomiting, acidosis, coma, and death.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Lactic Acidosis</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Cofactor for <span class=\"customMeta\" data-dictid=\"f9129e152d16927771960c4ccc40bc\">pyruvate</span> dehydrogenase, converting <span class=\"customMeta\" data-dictid=\"f9129e152d16927771960c4ccc40bc\">pyruvate</span> to acetyl-CoA</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Impaired conversion leads to increased <span class=\"customMeta\" data-dictid=\"5a751dc161169277719123aae1b764\">lactate</span> and <span class=\"customMeta\" data-dictid=\"f9129e152d16927771960c4ccc40bc\">pyruvate</span> levels, causing <span class=\"customMeta\" data-dictid=\"b82539c9ae1692777191a3f7ddd7bb\">lactic</span> acidosis.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a child brought to the orthopedics OPD with a lower limb deformity and hyperpigmented skin lesions, based on the presented X-ray of her thigh?", "options": [{"label": "A", "text": "Non-ossifying fibroma", "correct": false}, {"label": "B", "text": "Fibrous dysplasia", "correct": true}, {"label": "C", "text": "Paget's disease", "correct": false}, {"label": "D", "text": "Osteogenesis imperfecta", "correct": false}], "correct_answer": "B. Fibrous dysplasia", "question_images": ["https://image.prepladder.com/content/NqDjWX9ja3OejA6EOY6E1745302008.png"], "explanation_images": ["https://image.prepladder.com/content/GERUYHAlqry44iDPSeF01745302063.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Non-inherited developmental disorder causing replacement of bone by <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">fibrous</span> tissue</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>GNAS1</strong> gene <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> (Chromosome 20)</li>\n<li>Associated with <strong>McCune Albright syndrome - Polyostotic <span class=\"customMeta\" data-dictid=\"5d6dfa73b316927772028f3cd60f7f\">Fibrous</span> Dysplasia</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Usually presents in the 2nd decade</li>\n<li>Progressive limb pain, swelling</li>\n<li>Limb deformities with associated fractures</li>\n<li><strong>Skin lesions (seen with McCune Albright syndrome)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Radiography</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>X-ray: well defined expansile <span class=\"customMeta\" data-dictid=\"5b22285eec169277719026820db11c\">intramedullary</span> lesions with ‘<strong>Ground glass</strong>’ appearance, <strong>‘shepherd crook deformity’</strong>.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Ian Bickle\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/shepherd-crook-deformity-polyostotic-fibrous-dysplasia\" data-tags=\"\" height=\"402\" src=\"https://image.prepladder.com/content/GERUYHAlqry44iDPSeF01745302063.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>MRI: is done to know the full extent of the disease</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Medical: <strong>Bisphosphonates</strong></li>\n<li>Surgical: <span class=\"customMeta\" data-dictid=\"ce2b48d83d1692777185427cee6c98\">Deformity</span> <span class=\"customMeta\" data-dictid=\"92a52a7756169277718538d58fe1a9\">correction</span> surgeries</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A chronic alcoholic patient is diagnosed with gouty arthritis. What biochemical changes will be seen in this patient?", "options": [{"label": "A", "text": "Decreased NADH/NAD+ ratio", "correct": false}, {"label": "B", "text": "Increased urea and urate levels", "correct": false}, {"label": "C", "text": "Increased urate and lactate levels", "correct": true}, {"label": "D", "text": "Increased level of alkaline phosphatase", "correct": false}], "correct_answer": "C. Increased urate and lactate levels", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Drug contraindicated in asthma patients during the management of postpartum haemorrhage is", "options": [{"label": "A", "text": "Carboprost", "correct": true}, {"label": "B", "text": "Oxytocin", "correct": false}, {"label": "C", "text": "Dinoprostone", "correct": false}, {"label": "D", "text": "Methyl ergometrine", "correct": false}], "correct_answer": "A. Carboprost", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - C\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child presents with erythematous scaly patches in the perioral region, mucosal ulcers, and impaired epithelial wound healing. The most likely mineral deficiency associated with this condition is", "options": [{"label": "A", "text": "Iron deficiency", "correct": false}, {"label": "B", "text": "Zinc deficiency", "correct": true}, {"label": "C", "text": "Calcium deficiency", "correct": false}, {"label": "D", "text": "Copper deficiency", "correct": false}], "correct_answer": "B. Zinc deficiency", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presenting with bleeding gums and easy bruisability was diagnosed with scurvy. This is due to", "options": [{"label": "A", "text": "Low calcium", "correct": false}, {"label": "B", "text": "Defective collagen formation", "correct": true}, {"label": "C", "text": "Inhibition of clotting factors", "correct": false}, {"label": "D", "text": "Increased keratinization of epithelium", "correct": false}], "correct_answer": "B. Defective collagen formation", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with swelling in the groin region, diagnosed as a direct inguinal hernia . Weakness in which of the following structures is most likely to cause this condition?", "options": [{"label": "A", "text": "Pectineal ligament", "correct": false}, {"label": "B", "text": "Conjoint tendon", "correct": true}, {"label": "C", "text": "Reflected part of inguinal ligament", "correct": false}, {"label": "D", "text": "Lacunar ligament", "correct": false}], "correct_answer": "B. Conjoint tendon", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with a previous MI and ventricular arrhythmia is on treatment for a few months. He developed fatigue, dyspnea and weight gain. He had also developed pulmonary fibrosis. Which of the following drugs is responsible for this?", "options": [{"label": "A", "text": "Amiodarone", "correct": true}, {"label": "B", "text": "Atenolol", "correct": false}, {"label": "C", "text": "Aspirin", "correct": false}, {"label": "D", "text": "Spironolactone", "correct": false}], "correct_answer": "A. Amiodarone", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - Amiodarone </p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Mechanism of Action</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Prolonged <span class=\"customMeta\" data-dictid=\"1313ac90ca16927771807502911c57\">action potential</span> duration and QT interval by <span class=\"customMeta\" data-dictid=\"9dc12b322016927771830dff673eeb\">blocking</span> delayed <span class=\"customMeta\" data-dictid=\"294e2000571692777197bec3311923\">rectifier</span> K+ channels.</li>\n<li>Blocks inactivated Na<sup>+</sup> channels, with rapid channel recovery (Decrease <span class=\"customMeta\" data-dictid=\"a2ffa3fa8f1692777195ceee9dafdd\">phase 0</span> slope).</li>\n<li>Partially inhibits myocardial Ca<sup>2+</sup> channels, adding to its <span class=\"customMeta\" data-dictid=\"2f4652078816927771814621857a81\">antiarrhythmic</span> effects.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Adverse effects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hypotension and <span class=\"customMeta\" data-dictid=\"c933e533971692777183b764d960d0\">Bradycardia</span> (with i.v administration or after drug accumulation)</li>\n<li>Photosensitivity<strong>: </strong>Skin <span class=\"customMeta\" data-dictid=\"b5f46d7e431692777195efd6b43e9f\">pigmentation</span> - Purple color (Purple man syndrome, smurf syndrome)</li>\n<li><strong>Corneal microdeposits:</strong> <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">Reversible</span> upon drug discontinuation.</li>\n<li>Pulmonary <span class=\"customMeta\" data-dictid=\"6e483e166a169277718133d060d311\">alveolitis</span> and <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> (On long-term use)</li>\n<li>Peripheral neuropathy</li>\n<li>Thyroid Dysfunction: Interfere with <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> function as it acts as a source of <span class=\"customMeta\" data-dictid=\"58c4fcb71116927771901e83ac026f\">iodine</span> and can potentially lead to goitre, <span class=\"customMeta\" data-dictid=\"8d4d1904791692777189941782330d\">hypothyroidism</span> <strong>(Wolf Chaikoff effect)</strong>, or, in rare cases, <span class=\"customMeta\" data-dictid=\"df46bcd43116927771892090901263\">hyperthyroidism</span> <strong>(Jos-Basedow effect).</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Drug Interactions</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Inhibits CYP3A4, CYP2C9, and P-glycoprotein,</strong> leading to potential interactions with drugs metabolized by this system.</li>\n<li>Increases <span class=\"customMeta\" data-dictid=\"a0e40688fa169277719572bdb48c92\">plasma</span> levels of <span class=\"customMeta\" data-dictid=\"508c1bf22216927771860525d4ef6f\">digoxin</span> and warfarin.</li>\n<li>Additive <span class=\"customMeta\" data-dictid=\"78a0565f7316927771827e4aca866c\">AV block</span> with beta-blockers or <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> channel blockers.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What could be the likely diagnosis based on the x-ray image of a 22-year-old female?", "options": [{"label": "A", "text": "Chondroblastoma", "correct": false}, {"label": "B", "text": "Osteochondroma", "correct": false}, {"label": "C", "text": "Giant cell tumor", "correct": true}, {"label": "D", "text": "Aneurysmal bone cyst", "correct": false}], "correct_answer": "C. Giant cell tumor", "question_images": ["https://image.prepladder.com/content/1nADr6lpgeemZJBulW2T1745302870.png"], "explanation_images": ["https://image.prepladder.com/content/q5XwsfmaNT0yNAZ4Ehl01745302952.png", "https://image.prepladder.com/content/YVbWup8izR975xIjCJCb1745302952.png", "https://image.prepladder.com/content/W14h9nWIeHxvr2gcwkhb1745302952.png", "https://image.prepladder.com/content/B33jyIElnN4rSCDXgvwx1745302952.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Benign but locally aggressive tumor of bone.<strong> </strong></li>\n<li>It commonly arises from epiphysis.</li>\n<li>MC Age: 20 and 45 years of age.</li>\n<li>Females &gt; males.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sites affected</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Distal <span class=\"customMeta\" data-dictid=\"512283ec9816927772024c89478b7d\">femur</span> &gt; <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> <span class=\"customMeta\" data-dictid=\"ca6af868811692777200ce067e9db9\">tibia</span> &gt; <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> <span class=\"customMeta\" data-dictid=\"ec7c10c0421692777197d151a4c0b5\">radius</span> &gt; sacrum.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Malignancy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Malignant transformation in &lt;1% of cases.</li>\n<li>Lungs are the most common site for metastases.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Swelling, vague pain.</li>\n<li>Pathological fracture.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Radiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>X-ray: Expansile <span class=\"customMeta\" data-dictid=\"897ef2d27c16927771861eb7f4726c\">eccentric</span> <span class=\"customMeta\" data-dictid=\"d54da38aaa1692777191560f60c0f9\">lytic</span> <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> on epiphysis</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Andreas F Mavrogenis, Vasilios Igoumenou, Panayiotis D. Megaloikonomos, Georgios N. Panagopoulos, Panayiotis J Papagelopoulos, Panayotis N. Soucacos\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Campanacci-et-al-3-grading-system-for-GCT-that-is-based-on-the-radiographic-appearance_fig1_319707094\" data-tags=\"\" height=\"385\" src=\"https://image.prepladder.com/content/q5XwsfmaNT0yNAZ4Ehl01745302952.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Extended <span class=\"customMeta\" data-dictid=\"f857ee35331692777185a5895e53b5\">curettage</span> with Bone grafting</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child before playing consumed fruit from the garden. After some time, he developed a high fever, confusion, photophobia, and was unable to urinate. What are the likely causative agent and the appropriate antidote used in this case of poisoning?", "options": [{"label": "A", "text": "Datura, Pralidoxime", "correct": false}, {"label": "B", "text": "Datura, Physostigmine", "correct": true}, {"label": "C", "text": "Yellow oleander, Pralidoxime", "correct": false}, {"label": "D", "text": "Yellow oleander, Physostigmine", "correct": false}], "correct_answer": "B. Datura, Physostigmine", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/p7irx6tE38DxnZxLR5pe1745302635.png"], "explanation": "<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td>\n<ul>\n<li>Dryness of mouth and throat</li>\n<li>Dysphagia</li>\n<li>Difficulty in talking</li>\n<li>Hoarseness of voice</li>\n<li>Flushed face</li>\n<li>Pupil dilatation</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Photophobia + Diplopia</li>\n<li>Agitation and restlessness</li>\n<li>Delirium</li>\n<li>Urinary retention</li>\n<li>Dry and hot skin</li>\n<li>Exfoliation of skin may occur</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Toxicity </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Antidote </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mechanism of action </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Datura/anticholinergics toxicity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Physostigmine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inhibits <span class=\"customMeta\" data-dictid=\"63b92227451692777180db3901b72f\">acetylcholinesterase</span> enzyme</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Opium </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Naloxone</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Opioid <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antagonist</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Organophosphates </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Atropine</p>\n<p>Pralidoxime</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Muscarinic antagonist</p>\n<p>Cholinesterase reactivation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acetaminophen </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>N-acetyl-cysteine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Replenishes Glutathione</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Methanol </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fomepizole</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inhibitor of alcohol dehydrogenase</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Benzodiazepine </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Flumazenil</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inhibits GABA receptors</p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cyanide </strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Eli Lilly <span class=\"customMeta\" data-dictid=\"5e612ce1381692777181adc76f11e6\">antidote</span> Kit (3-step approach)</p>\n</td>\n<td colspan=\"1\" rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ol>\n<li>Amyl nitrate: Oxidises haemoglobin to methemoglobin, which scavenges cyanide.</li>\n<li>Sodium nitrate: causes <span class=\"customMeta\" data-dictid=\"2cf30efe831692777185e200487656\">cyanide</span> to detach from the <span class=\"customMeta\" data-dictid=\"d4fff554a316927771885dc8700abe\">heme</span> group of <span class=\"customMeta\" data-dictid=\"29e8e2a5dd16927771855db589c581\">cytochrome</span> oxidase.\n\t\t\t\t<ul>\n<li>Amyl <span class=\"customMeta\" data-dictid=\"ad09a76257169277719349e2735418\">nitrate</span> is used as a temporary measure until IV Sodium <span class=\"customMeta\" data-dictid=\"ad09a76257169277719349e2735418\">nitrate</span> can be given.</li>\n</ul>\n</li>\n<li>Sodium thiosulphate:It activates an <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> that converts <span class=\"customMeta\" data-dictid=\"2cf30efe831692777185e200487656\">cyanide</span> to a less toxic agent, thiocyanate.</li>\n</ol>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is seen in low insulin:glucagon ratio?", "options": [{"label": "A", "text": "Activation of lipoprotein lipase", "correct": false}, {"label": "B", "text": "Activation of glycogen synthase", "correct": false}, {"label": "C", "text": "Activation of phosphofructokinase", "correct": false}, {"label": "D", "text": "Activation of hormone-sensitive lipase", "correct": true}], "correct_answer": "D. Activation of hormone-sensitive lipase", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Drug Class</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Effect on Insulin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Effect on Glucagon</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>IGR</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Implications</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sulfonylureas (e.g., Glimepiride)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No change</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increases IGR, beneficial in insulinopenic states.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>DPP4 inhibitors (e.g., Sitagliptin)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Increases IGR, improves alpha-cell sensitivity.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>GLP-1RAs (e.g., Liraglutide)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓/No change</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No change/↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Variable effects; may aid in normalizing IGR.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>SGLT2 inhibitors (e.g., Empagliflozin)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↑</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reduces IGR; supports weight loss, mimics <span class=\"customMeta\" data-dictid=\"5f526a682c16927771831cac5b3711\">calorie</span> restriction.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Metformin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No change</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Reduces hyperinsulinemia, lowers IGR.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pioglitazone</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>–</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Insulin sensitizer, reduces IGR.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Alpha-glucosidase inhibitors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>No change</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>↓</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Decreases IGR, promotes weight loss.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The method of autopsy carried out en masse to remove from the tongue to the prostate is:", "options": [{"label": "A", "text": "Virchow technique", "correct": false}, {"label": "B", "text": "Rokitansky technique", "correct": false}, {"label": "C", "text": "Ghon technique", "correct": false}, {"label": "D", "text": "Letulle technique", "correct": true}], "correct_answer": "D. Letulle technique", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young female comes to the emergency department after consuming 100 aspirin tablets. What should be the next step in management?", "options": [{"label": "A", "text": "N-acetyl cysteine to replenish glutathione stores", "correct": false}, {"label": "B", "text": "Pralidoxime", "correct": false}, {"label": "C", "text": "Glucagon to control bradycardia and hypoglycemia", "correct": false}, {"label": "D", "text": "Give sodium bicarbonate to alkalize urine", "correct": true}], "correct_answer": "D. Give sodium bicarbonate to alkalize urine", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/e2Rd6RkF25hcMx3r0Yvh1745303240.png"], "explanation": "<p>Correct Answer D - Give sodium &lt;span class=\"customMeta\" data-dictid=\"2311c3b4ac16927771831d4c919043\"&gt;bicarbonate&lt;/span&gt; to &lt;span class=\"customMeta\" data-dictid=\"11dc8d57a01692777181568b2b8461\"&gt;alkalize&lt;/span&gt; u\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 42-year-old HIV-positive patient died, and his body was brought for post-mortem. The method of autopsy to be done is:", "options": [{"label": "A", "text": "Ghon technique", "correct": false}, {"label": "B", "text": "Letulle technique", "correct": false}, {"label": "C", "text": "Virchow technique", "correct": false}, {"label": "D", "text": "Rokitansky technique", "correct": true}], "correct_answer": "D. Rokitansky technique", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A construction worker presents to the OPD with complaints of white fingers. He has been working in the cement and concrete industry and has spent 20 years using heavy machinery drills and polishing wood and furniture. What is the most likely etiology for this condition?", "options": [{"label": "A", "text": "Candidal infection of the fingers due to continuous exposure to water", "correct": false}, {"label": "B", "text": "Exposure to thinners and paints", "correct": false}, {"label": "C", "text": "Continuous exposure to cement and concrete", "correct": false}, {"label": "D", "text": "Continuous exposure to drills and machines", "correct": true}], "correct_answer": "D. Continuous exposure to drills and machines", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 4-year-old child presents with a rectal polyp and painless rectal bleeding. Histopathological examination reveals enlarged and inflamed glands filled with mucin. The child is diagnosed with a juvenile rectal polyp. Which of the following best describes the polyp in this case?", "options": [{"label": "A", "text": "Adenoma", "correct": false}, {"label": "B", "text": "Choristoma", "correct": false}, {"label": "C", "text": "Hamartoma", "correct": true}, {"label": "D", "text": "Carcinoma", "correct": false}], "correct_answer": "C. Hamartoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/RwzFHuAzycdtpjw5YumP1745916347.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the given condition:", "options": [{"label": "A", "text": "Venous ulcer", "correct": false}, {"label": "B", "text": "Malignant ulcer", "correct": false}, {"label": "C", "text": "Arterial ulcer", "correct": false}, {"label": "D", "text": "Trophic ulcer", "correct": true}], "correct_answer": "D. Trophic ulcer", "question_images": ["https://image.prepladder.com/notes/K238cJWqWRh7VS9vTSkn1745916348.png"], "explanation_images": ["https://image.prepladder.com/content/KfqlW8GIA9Q5KyFGdAa31745304743.png", "https://image.prepladder.com/content/sL2kWqATCDyyCNIIAf5a1745304743.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:734px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>History</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Lesion Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Pain</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Ischemic/Arterial</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Smoking, <span class=\"customMeta\" data-dictid=\"8502a8f15e16927771909160b28bf2\">intermittent</span> claudication</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Irregular edges, poor <span class=\"customMeta\" data-dictid=\"09e414c5a71692777188ef029aefe5\">granulation</span> tissue, dry necrotic base; round or <span class=\"customMeta\" data-dictid=\"7134f7f8681692777196fa644c43bf\">punched-out</span> with sharp demarcation</p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Jonathan Moore\" data-hash=\"\" data-license=\"CC BY 3.0\" data-source=\"https://en.wikipedia.org/wiki/Arterial_insufficiency_ulcer#/media/File:Arterial_ulcer_peripheral_vascular_disease.jpg\" data-tags=\"\" height=\"313\" src=\"https://image.prepladder.com/content/KfqlW8GIA9Q5KyFGdAa31745304743.png\" width=\"399\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Severe, particularly at night; relieved by dependency</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Venous</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Varicose veins, DVT, trauma, surgery, multiple pregnancies</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Shallow, irregular/shaggy shape, granulating base, fibrinous material with moderate to heavy exudate</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Nini00\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Venous_ulcer#/media/File:%C3%9Alceras_antes_da_cirurgia.JPG\" data-tags=\"\" height=\"313\" src=\"https://image.prepladder.com/content/sL2kWqATCDyyCNIIAf5a1745304743.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Mild; relieved by elevation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Neurotrophic</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Numbness, paresthesias, burning, loss of sensation in the foot, DM</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Punched-out, deep sinus, variable depth, partial <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> to severe, involving the tendon, fascia, joint capsule, or bone</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>None</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Malignant Ulcer</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>History of skin cancer (e.g., <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> or <span class=\"customMeta\" data-dictid=\"5be0ee4ea316927771997104326685\">squamous</span> cell carcinoma)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Irregular, raised borders, ulcerating tumour with hard, <span class=\"customMeta\" data-dictid=\"b3e55c05121692777190f2cc59fde0\">indurated</span> tissue</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Often painful, it can be associated with <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> or foul odour</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 10-year-old male child came to the casualty with difficulty in walking and pain in the perianal region. On subjecting the specimen from the perianal region to a test, it produces yellow needle-shaped rhombic crystals with picric acid. What is the test done?", "options": [{"label": "A", "text": "Barberio test", "correct": true}, {"label": "B", "text": "Florence test", "correct": false}, {"label": "C", "text": "Teichmann test", "correct": false}, {"label": "D", "text": "Acid phosphatase test", "correct": false}], "correct_answer": "A. Barberio test", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/pbPHRz4JlEZBgCpnNZer1745304737.png", "https://image.prepladder.com/content/jX9sbQUWpw9kJEMyd48G1745304746.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Test Name</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Substance Detected</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Result</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Reagent Used</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Mnemonic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p style=\"text-align:center\"><strong>Notes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Barberio Test</strong></p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Spermine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Yellow needle-shaped crystals of Spermine Picrate</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Picric acid</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Barbar picks your hair with a needle</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Detects Spermine from the prostate; confirms the presence of seminal fluid.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Florence Test</strong></p>\n<p><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Choline</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Dark brown rhombic crystals of <span class=\"customMeta\" data-dictid=\"ad6984dc581692777184936c84dd97\">Choline</span> iodide</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>KI (Potassium Iodide)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Florence has 'C', C for Choline</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>It detects <span class=\"customMeta\" data-dictid=\"ad6984dc581692777184936c84dd97\">choline</span> from the <span class=\"customMeta\" data-dictid=\"c78e813e3a1692777198261357cb13\">seminal vesicle</span> and is used to identify seminal fluid.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A chronic smoker was taking nicotine therapy and clonidine tablets for smoking de-addiction. He stopped taking clonidine tablets and developed a headache. What is the reason behind this?", "options": [{"label": "A", "text": "Postural hypotension", "correct": false}, {"label": "B", "text": "Receptor downregulation", "correct": false}, {"label": "C", "text": "Rebound hypertension", "correct": true}, {"label": "D", "text": "Receptor hypersensitivity", "correct": false}], "correct_answer": "C. Rebound hypertension", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer C - &lt;span class=\"customMeta\" data-dictid=\"a4812dcf9b169277719756aaf48b7c\"&gt;Rebound&lt;/span&gt; h\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Rebound Hypertension</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Symptoms </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A sudden increase in blood pressure, headache, palpitations, sweating, anxiety, dizziness, confusion, chest pain.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Diagnosis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Based on symptoms and <span class=\"customMeta\" data-dictid=\"263ee5444e1692777183a7e8e704da\">blood pressure</span> readings</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gradual tapering of the medication, <span class=\"customMeta\" data-dictid=\"263ee5444e1692777183a7e8e704da\">blood pressure</span> monitoring, and use of alternative medications if needed.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Prevention </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Avoid abrupt discontinuation of medications and gradual tapering under medical supervision.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient was brought to casualty with seizures. He had multiple episodes and was taking herbal medicines for the same. He was conscious in between the episodes. During the episodes, he had an arching of his back. What is the likely cause?", "options": [{"label": "A", "text": "Strychnine", "correct": true}, {"label": "B", "text": "Ricinus", "correct": false}, {"label": "C", "text": "Nerium odorum", "correct": false}, {"label": "D", "text": "Datura", "correct": false}], "correct_answer": "A. Strychnine", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/nh7Eiim8SeyZZ1YRH5Lz1745305099.png", "https://image.prepladder.com/content/dkONoZTJwvzZaCCwbVbR1745305109.png", "https://image.prepladder.com/content/MTrtSKbBDXcAnKiHkAcU1745305117.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Source</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Seeds of Strychnos nux-vomica and other species of Strychnos plants found in India.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"H. Zell \" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Strychnos_nux-vomica\" data-tags=\"\" height=\"246\" src=\"https://image.prepladder.com/content/nh7Eiim8SeyZZ1YRH5Lz1745305099.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of action </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Stimulates all parts of the central nervous system, especially the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> horn cells. Greatly increases <span class=\"customMeta\" data-dictid=\"20f478f55f1692777197e351415f8f\">reflex</span> <span class=\"customMeta\" data-dictid=\"3892cfe03616927771872f834cf855\">excitability</span> by removing normal <span class=\"customMeta\" data-dictid=\"f03ca2d2a716927771901227bc175a\">inhibition</span> of motor cell stimulation, causing widespread uncontrolled motor activity of the <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord.</li>\n<li>Slight <span class=\"customMeta\" data-dictid=\"7d7e9fdf401692777199f2038941b6\">stimuli</span> like noise, light, or a breeze can cause violent generalized muscle spasms</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"7\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td rowspan=\"7\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Opisthotonos</strong>- arched body with only the back of head and heels touching the ground:</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Charles Bell\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Opisthotonus\" data-tags=\"\" height=\"163\" src=\"https://image.prepladder.com/content/dkONoZTJwvzZaCCwbVbR1745305109.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>Emprosthotonos- forward curve</li>\n<li>Pleurothotonus- sideways curve</li>\n<li>Risus sardonicus- fixed grin:</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Moraru, Liviu &amp; Budianu, Mihaela-Alexandra &amp; Musteață, Isabela-Raluca &amp; Septimiu, Voidăzan. \" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/WD-characteristic-sign-of-risus-sardonicus-in-a-37-year-old-man_fig3_378982949\" data-tags=\"\" height=\"357\" src=\"https://image.prepladder.com/content/MTrtSKbBDXcAnKiHkAcU1745305117.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"7\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td rowspan=\"7\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Immediate Care: Place in a dark, quiet room.</li>\n<li>Anesthesia: Chloroform or <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> <span class=\"customMeta\" data-dictid=\"8815b1ff5b1692777182be93e820b0\">barbiturate</span> if spasms allow.</li>\n<li>Adsorption: Administer <span class=\"customMeta\" data-dictid=\"90974ed702169277718167b03c69c3\">animal charcoal</span> to absorb free strychnine, or <span class=\"customMeta\" data-dictid=\"86e6f9a240169277720098e68bfbbe\">tannic acid</span> if <span class=\"customMeta\" data-dictid=\"e7626b047e169277718484971217b8\">charcoal</span> is unavailable.</li>\n<li>Antidotes: <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">Intravenous</span> barbiturates to stop convulsions.</li>\n<li>Muscle relaxants: Mephenesin, <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> <span class=\"customMeta\" data-dictid=\"80d3ceeba61692777186f4f5da691f\">diazepam</span> for <span class=\"customMeta\" data-dictid=\"f350ca9b3516927771814951e4c70c\">anticonvulsant</span> effects.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Autopsy Findings</strong></p>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Rigor mortis: Sets in almost immediately<strong> </strong>and passes off early.</li>\n<li>Stomach contents: Remains of seeds may be found.</li>\n<li>Delayed putrefaction.</li>\n<li>Toxicological analysis: <span class=\"customMeta\" data-dictid=\"531c2333a41692777199152a47d1e6\">Strychnine</span> can be detected in putrefied bodies and viscera; brain and <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> cord should be preserved for analysis.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Differentiating Points</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Strychnine Poisoning</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Tetanus</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1. History</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>History of poisoning</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>History of injury</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2. Onset</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sudden onset</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gradual onset</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3. Convulsions/Spasms</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Generalized convulsions</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lockjaw (trismus)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4. Chest Movement</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chest fixed during convulsions</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Not typically fixed</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5. <span class=\"customMeta\" data-dictid=\"5bc49d94df16927771975eae86de9f\">Relaxation</span> Between Spasms</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Complete <span class=\"customMeta\" data-dictid=\"5bc49d94df16927771975eae86de9f\">relaxation</span> between seizures</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Relaxation between spasms is never complete</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6. Duration Until Fatality</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ends fatally within a few hours</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Death is rare within a few hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>7. Chemical Evidence</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chemical analysis reveals the poison</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No specific chemical detection</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with varicose veins complains of eczema in the same region. According to the CEAP guidelines, what is the stage of the clinical classification?", "options": [{"label": "A", "text": "C2", "correct": false}, {"label": "B", "text": "C3", "correct": false}, {"label": "C", "text": "C4a", "correct": true}, {"label": "D", "text": "C4b", "correct": false}], "correct_answer": "C. C4a", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/B3Gca73kLXwk1E4Qv2mf1745305324.png", "https://image.prepladder.com/content/aOicU3D144zUkAr1zlzO1745305324.png", "https://image.prepladder.com/content/lnNH7K6sfjO8qQpAOlMP1745305324.png", "https://image.prepladder.com/content/urb5bJ1YpovJkaaWbNrv1745305324.png"], "explanation": "<table>\n<thead>\n<tr>\n<th>Class</th>\n<th>Description</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>C0</td>\n<td>No visible or <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> signs of <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> disease</td>\n</tr>\n<tr>\n<td>C1</td>\n<td>Telangiectasia or <span class=\"customMeta\" data-dictid=\"0b6b1f44cb1692777197afef785626\">reticular</span> veins (&lt;1–3 mm)</td>\n</tr>\n<tr>\n<td>C2</td>\n<td>Varicose veins (&gt;3 mm)</td>\n</tr>\n<tr>\n<td>C3</td>\n<td>Edema without skin changes</td>\n</tr>\n<tr>\n<td>C4a</td>\n<td>Pigmentation or eczema</td>\n</tr>\n<tr>\n<td>C4b</td>\n<td>Lipodermatosclerosis (LDS) or <span class=\"customMeta\" data-dictid=\"b04fb2c703169277718295309e32d6\">atrophie</span> blanche</td>\n</tr>\n<tr>\n<td>C4c</td>\n<td>Corona phlebectatica</td>\n</tr>\n<tr>\n<td>C5</td>\n<td>Healed <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> ulcer</td>\n</tr>\n<tr>\n<td>C6</td>\n<td>Active <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> ulcer</td>\n</tr>\n</tbody>\n</table>\n<table>\n<thead>\n<tr>\n<th>Code</th>\n<th>Description</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>Ec</td>\n<td>Congenital</td>\n</tr>\n<tr>\n<td>Ep</td>\n<td>Primary</td>\n</tr>\n<tr>\n<td>Es</td>\n<td>Secondary (e.g., post-thrombotic)</td>\n</tr>\n<tr>\n<td>En</td>\n<td>No <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> <span class=\"customMeta\" data-dictid=\"4711a65634169277718737b781005d\">etiology</span> identified</td>\n</tr>\n</tbody>\n</table>\n<table>\n<thead>\n<tr>\n<th>Code</th>\n<th>Description</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>As</td>\n<td>Superficial veins</td>\n</tr>\n<tr>\n<td>Ap</td>\n<td>Perforator veins</td>\n</tr>\n<tr>\n<td>Ad</td>\n<td>Deep veins</td>\n</tr>\n<tr>\n<td>An</td>\n<td>No <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> location identified</td>\n</tr>\n</tbody>\n</table>\n<table>\n<thead>\n<tr>\n<th>Code</th>\n<th>Description</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>Pr</td>\n<td>Reflux</td>\n</tr>\n<tr>\n<td>Po</td>\n<td>Obstruction</td>\n</tr>\n<tr>\n<td>Pr,o</td>\n<td>Reflux and obstruction</td>\n</tr>\n<tr>\n<td>Pn</td>\n<td>No identifiable pathology</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Section 314 IPC deals with", "options": [{"label": "A", "text": "Causing miscarriage with the consent of the mother", "correct": false}, {"label": "B", "text": "Causing miscarriage without the consent of the mother", "correct": false}, {"label": "C", "text": "Death of the mother by act done with intent to cause miscarriage", "correct": true}, {"label": "D", "text": "Causing the death of the quick unborn child by an act amounting to culpable homicide", "correct": false}], "correct_answer": "C. Death of the mother by act done with intent to cause miscarriage", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>IPC Section</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">312</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Causing miscarriage. <strong>(Option A ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">313</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Causing <span class=\"customMeta\" data-dictid=\"423516578d1692777192412d27cc61\">miscarriage</span> without a woman's consent. <strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">314</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Death caused by an act done with intent to cause miscarriage, if act done without woman's consent. <strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">315</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Act done with intent to prevent a child being born alive or to cause it to die after birth.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">316</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Causing death of a quick unborn child by act amounting to culpable homicide. <strong>(Option D ruled out)</strong></p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A physician prescribed a drug that reduces the synthesis of uric acid for the gout. Identify the drug.", "options": [{"label": "A", "text": "Probenecid", "correct": false}, {"label": "B", "text": "Colchicine", "correct": false}, {"label": "C", "text": "Diclofenac", "correct": false}, {"label": "D", "text": "Allopurinol", "correct": true}], "correct_answer": "D. Allopurinol", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - Allopu\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Drug </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mechanism of action </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Side effects</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Allopurinol</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Xanthine <span class=\"customMeta\" data-dictid=\"4a14dfa14e1692777194882f818d87\">oxidase</span> inhibitor</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rash, diarrhea, nausea, liver function test abnormalities</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Febuxostat</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Xanthine <span class=\"customMeta\" data-dictid=\"4a14dfa14e1692777194882f818d87\">oxidase</span> inhibitor</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Nausea, rash, liver function test abnormalities</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Probenecid</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Uriosuric agent</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rash, <span class=\"customMeta\" data-dictid=\"b3a647ce2516927771881427f56c1d\">gastrointestinal</span> symptoms</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Colchicine</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anti-inflammatory</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Diarrhea, nausea, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain, myopathy, <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> suppression, <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> neuropathy</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The temperature of the body of a deceased person is found to be 39°C. Which of the following is the most probable reason?", "options": [{"label": "A", "text": "Cyanide poisoning", "correct": false}, {"label": "B", "text": "Septicemia", "correct": true}, {"label": "C", "text": "Corrosive poisoning", "correct": false}, {"label": "D", "text": "Intra-abdominal hemorrhage", "correct": false}], "correct_answer": "B. Septicemia", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1. Disturbed heat regulation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2. Increased heat production (excessive muscle contraction)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3. Excessive bacterial activity</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Sunstroke</li>\n<li>Pontine hemorrhage</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Tetanus</li>\n<li>Strychnine poisoning</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Septicaemia</li>\n<li>Cholera</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most appropriate course of action for the management of a patient who presents to the emergency department with a severe headache and has a blood pressure reading of 160/100 mmHg, along with a CT scan showing evidence of a subarachnoid haemorrhage?", "options": [{"label": "A", "text": "Nimodipine", "correct": false}, {"label": "B", "text": "Angiography", "correct": true}, {"label": "C", "text": "Surgery", "correct": false}, {"label": "D", "text": "Fibrinolytic therapy", "correct": false}], "correct_answer": "B. Angiography", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:550px\">\n<thead>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Grade I</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>No bleeding.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Grade II</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Diffuse SAH with layers &lt;1mm thick.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Grade III</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Localised clots or SAH layers &gt;1mm thick.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Grade IV</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>SAH minimal/absent, with intracerebral/intraventricular haemorrhage.</p>\n</td>\n</tr>\n</thead>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 20-year-old female patient consumed a cleaning product containing 90% sodium hydroxide. She is having complete dysphagia. What is the best step in management?", "options": [{"label": "A", "text": "Esophagojejunostomy", "correct": false}, {"label": "B", "text": "Stent placement", "correct": false}, {"label": "C", "text": "Feeding jejunostomy", "correct": true}, {"label": "D", "text": "Gastrojejunostomy", "correct": false}], "correct_answer": "C. Feeding jejunostomy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:654px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Alkali causes liquefaction, saponification, and <span class=\"customMeta\" data-dictid=\"3e745919391692777200fae21b7251\">thrombosis</span> of vessels, leading to <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> and stricture.</li>\n<li>Acid causes intense pylorospasm, antral pooling, <span class=\"customMeta\" data-dictid=\"42f1e4deb8169277718412c0681a54\">coagulation</span> necrosis, and <span class=\"customMeta\" data-dictid=\"6b73f3afaa1692777187f2899b6934\">eschar</span> formation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Acute Phase Management</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Neutralization: vinegar/citrus for alkali; antacids/milk/egg whites for acid</li>\n<li>Early <span class=\"customMeta\" data-dictid=\"a9e7c4b7051692777187a218b539d7\">endoscopy</span> to assess severity and extent</li>\n<li>Avoid emetics and sodium <span class=\"customMeta\" data-dictid=\"2311c3b4ac16927771831d4c919043\">bicarbonate</span> to prevent perforation</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"13\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management by Burn Degree</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>1st Degree Burns:</strong></p>\n<ul>\n<li>48 hours observation; oral feeds resumed once <span class=\"customMeta\" data-dictid=\"6b0184a84d16927771981289924c2a\">saliva</span> is swallowed painlessly</li>\n<li>Regular follow-up <span class=\"customMeta\" data-dictid=\"a9e7c4b7051692777187a218b539d7\">endoscopy</span> at 1st, 2nd, and 8th months to identify stricture</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"10\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>2nd &amp; 3rd Degree Burns:</strong></p>\n<ul>\n<li>Fluid therapy, antibiotics, nutrition, PPIs and aerosolised steroids and resuscitation</li>\n<li>Fiberoptic-guided <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> intubation/tracheostomy, if necessary.</li>\n<li>Endoscopic <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> stenting, <strong>jejunostomy for feeding.</strong></li>\n<li>Laparoscopy for evaluation; <span class=\"customMeta\" data-dictid=\"a422b7cfac1692777191bf0a3499e4\">laparotomy</span> in unstable patients</li>\n<li>Resection and end <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> <span class=\"customMeta\" data-dictid=\"c4b16dd0101692777187f46fd03084\">esophagostomy</span> with <span class=\"customMeta\" data-dictid=\"f60fefbb051692777190814df1bedd\">jejunostomy</span> if <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> is full thickness.</li>\n<li>Consider re-exploration after 36-48 hours if necessary.</li>\n<li>Regular <span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\">endoscopic</span> <span class=\"customMeta\" data-dictid=\"29a08d8f9216927771869ed797367e\">dilatation</span> for stricture</li>\n<li>Use of various dilators (e.g., balloon, Savary-Gilliard, Eder-Puestow) for <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> dilatation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Surgical Considerations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Esophageal <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> is technically difficult; <span class=\"customMeta\" data-dictid=\"4fc6b3ee501692777183061d4f55ff\">bypass</span> may be preferred</li>\n<li>Resection and end <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> <span class=\"customMeta\" data-dictid=\"c4b16dd0101692777187f46fd03084\">esophagostomy</span> with <span class=\"customMeta\" data-dictid=\"f60fefbb051692777190814df1bedd\">jejunostomy</span> if <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> is full thickness</li>\n<li>A <span class=\"customMeta\" data-dictid=\"566fcef0991692777184068f36db82\">colonic</span> <span class=\"customMeta\" data-dictid=\"2533659200169277718431206e4029\">conduit</span> may be used if the stomach is diseased</li>\n<li>Multiple strictures may require <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> <span class=\"customMeta\" data-dictid=\"17b5bd50d91692777197ea9cb7f468\">resection</span> and <span class=\"customMeta\" data-dictid=\"566fcef0991692777184068f36db82\">colonic</span> transposition</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with a malignancy is undergoing chemotherapy; his platelet counts were reduced during the previous cycle of chemotherapy. What time will you give this to prevent/treat this condition?", "options": [{"label": "A", "text": "Oprelvekin (IL-11)", "correct": true}, {"label": "B", "text": "Filgrastim", "correct": false}, {"label": "C", "text": "Erythropoietin", "correct": false}, {"label": "D", "text": "Amifostine", "correct": false}], "correct_answer": "A. Oprelvekin (IL-11)", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - &lt;span class=\"customMeta\" data-dictid=\"73e490ea3f1692777194b3e2311f72\"&gt;Oprelvekin&lt;/span&gt; (IL-11)\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Hematopoietic drugs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mechanism of action </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Adverse effects</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Erythropoietin </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Stimulates the production of red blood cells in the bone marrow</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anemia due to chronic <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease, cancer chemotherapy, <span class=\"customMeta\" data-dictid=\"fa9d83d3d41692777189a8b393dd60\">HIV</span> therapy</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hypertension, headache, nausea, vomiting, allergic reactions, thrombotic events</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Filgrastim </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Stimulates the production of neutrophils in the bone marrow</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Neutropenia due to cancer <span class=\"customMeta\" data-dictid=\"8602c4b260169277718439bb122cb0\">chemotherapy</span> or <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> transplant</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bone pain, fever, headache, fatigue, nausea, vomiting</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Sargramostim </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Stimulates the production of white blood cells, including neutrophils, monocytes, eosinophils, and <span class=\"customMeta\" data-dictid=\"77f797c5e8169277718535480fa7fd\">dendritic</span> cells</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Neutropenia due to cancer <span class=\"customMeta\" data-dictid=\"8602c4b260169277718439bb122cb0\">chemotherapy</span> or <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> transplant, <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> failure syndromes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bone pain, fever, headache, fatigue, nausea, vomiting, allergic reactions</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Oprelvekin </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Stimulates the production of platelets in the bone marrow</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Thrombocytopenia due to cancer chemotherapy</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fluid retention, dyspnea, hypotension, allergic reactions, arrhythmias</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Eltrombopag </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Stimulates the production of platelets in the bone marrow</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Chronic immune thrombocytopenia, <span class=\"customMeta\" data-dictid=\"39867f177b16927771888cf43850d5\">hepatitis</span> C-induced thrombocytopenia</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Headache, nausea, diarrhea, <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> liver function tests, thrombotic events.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 23-year-old male patient presents with a swelling in the midline of his neck that shifts when he swallows or sticks out his tongue. What is the probable diagnosis?", "options": [{"label": "A", "text": "Brachial cyst", "correct": false}, {"label": "B", "text": "Thyroglossal cyst", "correct": true}, {"label": "C", "text": "Plunging ranula", "correct": false}, {"label": "D", "text": "Dermoid cyst", "correct": false}], "correct_answer": "B. Thyroglossal cyst", "question_images": ["https://image.prepladder.com/content/En3ZFxvrXhAZePMNqIPd1745305877.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A farmer was sleeping in the field, and he felt a sting on his leg. He saw something moving away quickly. He then got drowsy and was taken to the hospital. He developed pain around the site and continued to bleed profusely from the wound site. The wound became red with blisters. Which of the following is the most likely cause?", "options": [{"label": "A", "text": "Viper", "correct": true}, {"label": "B", "text": "Cobra", "correct": false}, {"label": "C", "text": "Wasp bite", "correct": false}, {"label": "D", "text": "Scorpion", "correct": false}], "correct_answer": "A. Viper", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Neurotoxic snakes (Elapidae)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Vasculotoxic (Viper)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Causes muscular, weakness of legs and <span class=\"customMeta\" data-dictid=\"72fa9105b916927771945aef35e8ed\">paralysis</span> of muscles of face, throat and respiration.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Causes <span class=\"customMeta\" data-dictid=\"11d4157da4169277718762144a4fe7\">enzymatic</span> destruction of cell walls and <span class=\"customMeta\" data-dictid=\"42f1e4deb8169277718412c0681a54\">coagulation</span> disorders causing hemolysis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ptosis: B/L drooping of <span class=\"customMeta\" data-dictid=\"819ddea9e51692777187cdff06b437\">eyelid</span> -M/C</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>DIC - </strong>Disseminated <span class=\"customMeta\" data-dictid=\"837d6227d81692777190a063ea2cd4\">Intravascular</span> <span class=\"customMeta\" data-dictid=\"09376c06ef16927771848108fd8f70\">Coagulopathy</span> causing <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Local reaction: Minimal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Local reaction: Extensive</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tongue <span class=\"customMeta\" data-dictid=\"72fa9105b916927771945aef35e8ed\">paralysis</span> seen</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tongue not affected</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Descending paralysis, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> <span class=\"customMeta\" data-dictid=\"72fa9105b916927771945aef35e8ed\">paralysis</span> with dysphagia, <span class=\"customMeta\" data-dictid=\"513e3f58591692777186180423ae9f\">dysphonia</span> and dysarthria.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Circulatory failure</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Wet gangrene, early onset</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dry gangrene, late onset</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pulse: Initially normal, then irregular.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pulse: weak and irregular</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Coagulation not affected</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Coagulation with hemorrhagic manifestations</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal pupils</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Pupils dilated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypersalivation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal salivation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Staggering gait</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Not affected specifically</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An infant is brought by his parents with complaints that his urine turns black on standing. Which of the following metabolic disorders is most likely?", "options": [{"label": "A", "text": "Phenylketonuria", "correct": false}, {"label": "B", "text": "Alkaptonuria", "correct": true}, {"label": "C", "text": "Homocystinuria", "correct": false}, {"label": "D", "text": "Maple syrup urine disease", "correct": false}], "correct_answer": "B. Alkaptonuria", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:771px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Alkaptonuria</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rare <strong>autosomal recessive</strong> genetic disorder caused by a <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> of <strong>homogentisate 1,2 <span class=\"customMeta\" data-dictid=\"fd6641649b16927771869679be8da7\">dioxygenase</span> (HGD)</strong>, an <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> in the<strong> tyrosine <span class=\"customMeta\" data-dictid=\"5b1a045f5f169277719210c0ac7a1e\">metabolism</span> pathway.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Mechanism and Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Defective tyrosine <span class=\"customMeta\" data-dictid=\"5b1a045f5f169277719210c0ac7a1e\">metabolism</span> → <span class=\"customMeta\" data-dictid=\"d442747c48169277718942db69fa7e\">homogentisic acid</span> (HGA) accumulation → ochronotic <span class=\"customMeta\" data-dictid=\"05e2e2617c16927771952bcbeea08b\">pigment</span> deposition → <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> disease (ochronosis).</p>\n<p> </p>\n<ul>\n<li>Deficiency: HGD fails to convert <span class=\"customMeta\" data-dictid=\"c7e11ce205169277718921ef0ce2d1\">HGA</span> to maleylacetoacetate.</li>\n<li>Consequences:\n\t\t\t\t<ul>\n<li>HGA oxidizes into melanin-like polymers → <span class=\"customMeta\" data-dictid=\"67e237a57c16927771859803f93ab3\">connective</span> tissue deposition (ochronosis).</li>\n<li>Affects joints, heart valves, kidneys, and vessels.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Triad: Homogentisic aciduria, ochronosis, ochronotic osteoarthropathy.</strong></li>\n<li><strong>Pediatric signs: Dark <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> (oxidized HGA).</strong></li>\n<li><strong>Musculoskeletal</strong>: <strong>Arthritis </strong>(spine, hips, knees), kyphoscoliosis, <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> stenosis.</li>\n<li><strong>Cardiac</strong>: A<strong>ortic stenosis, <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> disease, <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> disease.</strong></li>\n<li><strong>Renal/Metabolic:</strong> <strong>Stones </strong>(renal, gallbladder, prostate).</li>\n<li><strong>Neurological</strong>: <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">Peripheral</span> neuropathy, stroke.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Evaluation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Clinical scoring: AKU Severity Score Index</strong> (AKUSSI).</li>\n<li><strong>Diagnostic tests:</strong>\n<ul>\n<li><strong>Gold standard: <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">Urinary</span> <span class=\"customMeta\" data-dictid=\"c7e11ce205169277718921ef0ce2d1\">HGA</span> quantification via gas chromatography-mass spectrometry.</strong></li>\n<li>Genetic testing for HGD mutations.</li>\n<li>Imaging (CT/MRI): Joint involvement, valvular calcification.</li>\n<li>Echocardiography: Valvular abnormalities.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Symptomatic</strong>: Pain control, physiotherapy, joint surgery.</li>\n<li><strong>Diet</strong>: Low-protein diet (limited efficacy).</li>\n<li>Medications:\n\t\t\t\t<ul>\n<li><strong>Vitamin C</strong>: Reduces <span class=\"customMeta\" data-dictid=\"c7e11ce205169277718921ef0ce2d1\">HGA</span> <span class=\"customMeta\" data-dictid=\"224ea8a9e41692777194e81be113d8\">oxidation</span> but not <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> excretion.</li>\n<li><strong>Nitisinone</strong>: Inhibits tyrosine metabolism, reduces <span class=\"customMeta\" data-dictid=\"c7e11ce205169277718921ef0ce2d1\">HGA</span> &gt;95%. <strong>Side effects: tyrosinemia, leukopenia, thrombocytopenia.</strong></li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prognosis and Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Prognosis</strong>: Normal life expectancy; <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> quality of life (pain, sleep issues, disability).</li>\n<li><strong>Complications</strong>:\n\t\t\t\t<ul>\n<li>Stones (renal, gallbladder, salivary).</li>\n<li>Tendon/ligament ruptures.</li>\n<li>Osteopenia, fractures.</li>\n<li>Aortic calcification/stenosis.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young patient presents with a 5-day fever history and signs of hypotension, tachycardia, tachypnea, and altered mental status. Lab results show elevated white blood cell count, neutrophil proportion, and serum creatinine. The intern doctor plans to assess the quick Sequential Organ Failure Assessment (qSOFA) score for prognosis prediction and hospitalisation duration. Which elements are part of the qSOFA score?", "options": [{"label": "A", "text": "BP, RR, and CBC", "correct": false}, {"label": "B", "text": "Creatinine, PR, and BP", "correct": false}, {"label": "C", "text": "RR, Body temperature, and PR", "correct": false}, {"label": "D", "text": "SBP, RR, and GCS score", "correct": true}], "correct_answer": "D. SBP, RR, and GCS score", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child presents with bone pain and hepatosplenomegaly. A trephine biopsy and aspirate shows the following finding. Which of the following is the most likely enzyme deficient in this condition?", "options": [{"label": "A", "text": "Hexosaminidase", "correct": false}, {"label": "B", "text": "Glucocerebrosidase", "correct": true}, {"label": "C", "text": "Sphingomyelinase", "correct": false}, {"label": "D", "text": "Alpha 1,4-glucosidase", "correct": false}], "correct_answer": "B. Glucocerebrosidase", "question_images": ["https://image.prepladder.com/notes/jQrlD23bExK988JnuRBa1745906840.jpg"], "explanation_images": ["https://image.prepladder.com/notes/1s3f1FoIleF9D9XcGgDX1745906841.jpg"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:642px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Enzyme deficiency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tay-Sachs disease </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hexosaminidase A</p>\n<p><strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Mental retardation</li>\n<li>Blindness</li>\n<li>Muscular weakness</li>\n<li>Cherry red spots in the macula</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fabry disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>α-Galactosidase</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Skin rash</li>\n<li>Kidney failure (full symptoms only in males</li>\n<li>X-linked recessive)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Krabbe disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>β-Galactosidase</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Mental retardation</li>\n<li>Near absence of myelin</li>\n<li>Predominant neurological manifestation and <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> nerves causing <span class=\"customMeta\" data-dictid=\"696dd98be71692777185b10993da3e\">deafness</span> and blindness.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gaucher disease </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>β-Glucosidase</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Enlarged liver and spleen</li>\n<li>Erosion of long bones</li>\n<li>Mental <span class=\"customMeta\" data-dictid=\"680dfbc5a5169277719748281f877e\">retardation</span> in infants</li>\n<li>Anemia</li>\n<li>Thrombocytopenia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Niemann-Pick disease </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sphingomyelinase</p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Enlarged liver and spleen</li>\n<li>Mental retardation</li>\n<li>Fatal in early life</li>\n<li>Cherry red spot in macula</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Farber disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ceramidase</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hoarseness</li>\n<li>Dermatitis</li>\n<li>Skeletal deformation</li>\n<li>Mental retardation</li>\n<li>Fatal in early life</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the meaning of neoadjuvant chemotherapy in the context of a 54-year-old woman diagnosed with stage 2A cervical cancer?", "options": [{"label": "A", "text": "Chemotherapy is given along with radiation.", "correct": false}, {"label": "B", "text": "Chemotherapy is given during surgery.", "correct": false}, {"label": "C", "text": "Chemotherapy is given before radical surgery to reduce the bulk of the tumour.", "correct": true}, {"label": "D", "text": "Chemotherapy is given after radical surgery for micrometastases.", "correct": false}], "correct_answer": "C. Chemotherapy is given before radical surgery to reduce the bulk of the tumour.", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child presents with thinning of hair and scaling of the scalp. On taking further history, it is found that she consumes raw eggs in her diet regularly. The given manifestations are due to the deficiency of which of the following vitamins?", "options": [{"label": "A", "text": "Niacin", "correct": false}, {"label": "B", "text": "Pyridoxine", "correct": false}, {"label": "C", "text": "Biotin", "correct": true}, {"label": "D", "text": "Thiamine", "correct": false}], "correct_answer": "C. Biotin", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female patient presented with acne that is not resolving on oral isotretinoin and antibiotics therapy. Which of the following is the next best investigation?", "options": [{"label": "A", "text": "Look for dietary triggers", "correct": false}, {"label": "B", "text": "Evaluate for hyperandrogenism", "correct": true}, {"label": "C", "text": "Check for antibiotic resistance", "correct": false}, {"label": "D", "text": "Look for drug triggers", "correct": false}], "correct_answer": "B. Evaluate for hyperandrogenism", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child presents with mental retardation, bone pain, and inability to walk. On a fundoscopy examination, a cherry red spot is seen. There is no organomegaly.What is the most likely diagnosis?", "options": [{"label": "A", "text": "Tay-Sachs disease", "correct": true}, {"label": "B", "text": "Niemann-Pick disease", "correct": false}, {"label": "C", "text": "Hurler syndrome", "correct": false}, {"label": "D", "text": "Gaucher disease", "correct": false}], "correct_answer": "A. Tay-Sachs disease", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/bg1QMY4vruDjOOhZR0Aw1745906840.jpg"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:642px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Enzyme deficiency</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tay-Sachs disease (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hexosaminidase A</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Mental retardation</li>\n<li>Blindness</li>\n<li>Muscular weakness</li>\n<li>Cherry red spots in the macula</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fabry disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>α-Galactosidase</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Skin rash</li>\n<li>Kidney failure (full symptoms only in males</li>\n<li>X-linked recessive)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Krabbe disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>β-Galactosidase</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Mental retardation</li>\n<li>Near absence of myelin</li>\n<li>Predominant neurological manifestation and <span class=\"customMeta\" data-dictid=\"6b7b5460171692777185e6e2475f8c\">cranial</span> nerves causing <span class=\"customMeta\" data-dictid=\"696dd98be71692777185b10993da3e\">deafness</span> and blindness.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Gaucher disease (Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>β-Glucosidase</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Enlarged liver and spleen</li>\n<li>Erosion of long bones</li>\n<li>Mental <span class=\"customMeta\" data-dictid=\"680dfbc5a5169277719748281f877e\">retardation</span> in infants</li>\n<li>Anemia</li>\n<li>Thrombocytopenia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Niemann-Pick disease (Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sphingomyelinase</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Enlarged liver and spleen</li>\n<li>Mental retardation</li>\n<li>Fatal in early life</li>\n<li>Cherry red spot in macula</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Farber disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ceramidase</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hoarseness</li>\n<li>Dermatitis</li>\n<li>Skeletal deformation</li>\n<li>Mental retardation</li>\n<li>Fatal in early life</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:485px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Enzyme Deficiency</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tay-Sachs disease</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hexosaminidase A, S</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Fabry disease</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>α-Galactosidase</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Metachromatic leukodystrophy</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Arylsulfatase A</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Krabbe disease</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>β-Galactosidase</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gaucher disease</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>β-Glucosidase</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Niemann-Pick disease types A, B</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sphingomyelinase</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Farber disease</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ceramidase</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A lady developed a skin reaction, as shown in the image after using a hair dye. Which of the following chemicals is responsible for this condition?", "options": [{"label": "A", "text": "Pollen", "correct": false}, {"label": "B", "text": "Chromates", "correct": false}, {"label": "C", "text": "Balsam of Peru", "correct": false}, {"label": "D", "text": "p-Phenylenediamine", "correct": true}], "correct_answer": "D. p-Phenylenediamine", "question_images": ["https://image.prepladder.com/notes/58XZ6doMOpb01mHhWoQq1745911568.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The true statement among the following is ___:", "options": [{"label": "A", "text": "Telmisartan dose should be reduced in renal failure but not in hepatic failure.", "correct": false}, {"label": "B", "text": "Irbesartan dose should be reduced in case of mild-moderate hepatic failure and renal failure.", "correct": false}, {"label": "C", "text": "Candesartan dose should be reduced in mild-moderate liver failure but not in renal failure.", "correct": false}, {"label": "D", "text": "Losartan acts as a thromboxane A2 antagonist and inhibits platelet aggregation.", "correct": true}], "correct_answer": "D. Losartan acts as a thromboxane A2 antagonist and inhibits platelet aggregation.", "question_images": [], "explanation_images": [], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Losartan </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Indications </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hypertension, <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">diabetic</span> nephropathy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mechanism of action </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Angiotension II <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antagonist</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Adverse effects </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hypotension, hyperkalemia, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> impairment, dizziness, fatigue, cough, headache, upper <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Contraindications </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hypersensitivity to losartan, pregnancy, breastfeeding</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Drug interactions </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Potassium supplements and other drugs that increase <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> levels, NSAIDs, diuretics, rifampin, ritonavir</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Dosage form</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tablets (25mg, 50mg, 100mg)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Route of administration</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Oral</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Half-life </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1.5-2 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Precautions </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Use cautiously in <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> and <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> impairment, heart failure, and aortic stenosis.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a young woman who presents with a painless ulcer in the genital region accompanied by pain less swelling of the lymph nodes in the groin?", "options": [{"label": "A", "text": "Chancroid", "correct": false}, {"label": "B", "text": "Syphilis", "correct": true}, {"label": "C", "text": "Herpes genitalis", "correct": false}, {"label": "D", "text": "Granuloma inguinale", "correct": false}], "correct_answer": "B. Syphilis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient was given digoxin and started having side effects like nausea and vomiting. The serum concentration of digoxin was 4 ng/ml, and the plasma therapeutic range was 1 ng/ml. If the half-life of digoxin is 40 hours, what time is required till you can safely start digoxin again?", "options": [{"label": "A", "text": "40 hours", "correct": false}, {"label": "B", "text": "80 hours", "correct": true}, {"label": "C", "text": "120 hours", "correct": false}, {"label": "D", "text": "140-180 hours", "correct": false}], "correct_answer": "B. 80 hours", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - 80 hou\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is associated with the clinical condition shown in the image?", "options": [{"label": "A", "text": "Condylomata lata", "correct": false}, {"label": "B", "text": "Mole", "correct": false}, {"label": "C", "text": "Malignant melanoma", "correct": true}, {"label": "D", "text": "Basal cell carcinoma", "correct": false}], "correct_answer": "C. Malignant melanoma", "question_images": ["https://image.prepladder.com/content/Ylj2TrD6tJEiFotBQDbm1745306831.png"], "explanation_images": ["https://image.prepladder.com/notes/zCRlYS4xqBWLypaPJAb81745911572.png", "https://image.prepladder.com/content/vJbwhOwYfmqmZqbzyVyp1745306904.png", "https://image.prepladder.com/notes/GI8SVcpWd5tGxrE4Le6j1745911574.png", "https://image.prepladder.com/content/joimQ3A54DpqRB1HMUKP1745306919.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Site</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Image</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Superficial <span class=\"customMeta\" data-dictid=\"ad56eb6e551692777199ae4ce59798\">spreading</span> (M/C type)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Any (more common on the upper back and, in women, lower legs)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Brown mixed with bluish-red, bluish-black, reddish brown, and often whitish pink. The <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> border is often visibly and/or palpably raised</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"PDM036\" data-author=\"Ivan Bristow, Jonathan Bowling\" data-hash=\"11388\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Superficial-spreading-melanoma-on-the-ankle_fig1_24420940\" data-tags=\"April2025\" height=\"249\" src=\"https://image.prepladder.com/notes/zCRlYS4xqBWLypaPJAb81745911572.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lentigo maligna </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sun-exposed surfaces, particularly <span class=\"customMeta\" data-dictid=\"b5e3350aab16927771912aa39c71f5\">malar</span> region and temple</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>In flat portions, brown and <span class=\"customMeta\" data-dictid=\"1aa3f03ae516927772007bdf930201\">tan</span> predominate, but whitish grey sometimes present; in nodules, reddish brown, bluish grey, bluish-black.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Dermanonymous,\" data-hash=\"\" data-license=\"CC BY-SA 4.0\" data-source=\"https://en.wikipedia.org/wiki/Lentigo_maligna_melanoma\" data-tags=\"\" height=\"400\" src=\"https://image.prepladder.com/content/vJbwhOwYfmqmZqbzyVyp1745306904.png\" width=\"428\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acral <span class=\"customMeta\" data-dictid=\"8ee739e51016927771913ad23c6fd5\">lentiginous</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Palm, sole, nail bed, <span class=\"customMeta\" data-dictid=\"26080f047a169277719334625cadef\">mucous</span> membrane</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>In flat portions, dark brown; in raised lesions (plaques), brown-black or blue-black.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"PDM037\" data-author=\"Ivan Bristow, Katharine Acland\" data-hash=\"11389\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/publication/23288903_Acral_lentiginous_melanoma_of_the_foot_and_ankle_A_case_series_and_review_of_the_literature\" data-tags=\"April2025\" height=\"298\" src=\"https://image.prepladder.com/notes/GI8SVcpWd5tGxrE4Le6j1745911574.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nodular</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Any</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reddish blue, purple, or bluish-black; can be uniform or mixed with brown and black.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"0x6adb015 \" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Nodular_melanoma\" data-tags=\"\" height=\"213\" src=\"https://image.prepladder.com/content/joimQ3A54DpqRB1HMUKP1745306919.png\" width=\"213\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Stage</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Classification</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clarke</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Breslow</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">I</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Involvement of epidermis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">≤ 0.75 mm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">II</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Involvement of <span class=\"customMeta\" data-dictid=\"e4c62a77731692777187b9c7ded25d\">epidermis</span> + dermis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">0.76-1.5 mm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">III</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Involvement of <span class=\"customMeta\" data-dictid=\"532334711316927771865e5309b763\">dermal</span> papillae</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">1.5-4 mm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">IV</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Involvement of <span class=\"customMeta\" data-dictid=\"0b6b1f44cb1692777197afef785626\">reticular</span> dermis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">&gt;4 mm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">V</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Involvement of <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> tissue</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">-</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A defect in which of the following forms the structure marked below?", "options": [{"label": "A", "text": "Internal oblique B) External oblique C) Parietal peritoneum D) Fascia transversalis", "correct": false}, {"label": "B", "text": "External oblique", "correct": false}, {"label": "C", "text": "Parietal peritoneum", "correct": false}, {"label": "D", "text": "Fascia transversalis", "correct": true}], "correct_answer": "D. Fascia transversalis", "question_images": ["https://image.prepladder.com/notes/rh6Yn390aRyxYSZGz7NL1745904766.png"], "explanation_images": ["https://image.prepladder.com/notes/lQjz9mXjECzzAtDQCKbF1745904828.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Structure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:bottom\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Parietal peritoneum</strong></p>\n<p><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Most <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> structure.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Transversalis fascia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Has a <span class=\"customMeta\" data-dictid=\"359a8718a61692777185568ac80abb\">defect</span> called the deep inguinal ring, through which the <span class=\"customMeta\" data-dictid=\"52d0e8b461169277720097e2175a05\">testes</span> and <span class=\"customMeta\" data-dictid=\"85e718f46f1692777198c656f33992\">spermatic</span> cord pass. Site for <span class=\"customMeta\" data-dictid=\"2f73e160ba1692777190d65065c95b\">indirect</span> inguinal hernias. <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">Anterior</span> to <span class=\"customMeta\" data-dictid=\"51df38de3d1692777194ced4c4bab5\">parietal</span> peritoneum. Forms the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> in the whole extent.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Lateral <span class=\"customMeta\" data-dictid=\"9cc3973459169277720194a0847477\">umbilical</span> fold</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Formed by the <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> epigastric vessels.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Median <span class=\"customMeta\" data-dictid=\"9cc3973459169277720194a0847477\">umbilical</span> ligament</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Remnant of the <span class=\"customMeta\" data-dictid=\"cb43e65f8d16927772010a28d74bb4\">urachus</span> (from the allantois).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Medial <span class=\"customMeta\" data-dictid=\"9cc3973459169277720194a0847477\">umbilical</span> ligament</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Remnant of the obliterated <span class=\"customMeta\" data-dictid=\"9cc3973459169277720194a0847477\">umbilical</span> artery.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Pyramidalis muscle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Small muscle attaching to the <span class=\"customMeta\" data-dictid=\"fff48ca9da16927771966fd16bbacc\">pubic</span> bone. <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">Rectus</span> abdominis lies above it. Covered by the <span class=\"customMeta\" data-dictid=\"53951671cd16927771971ed604bcf4\">rectus</span> <span class=\"customMeta\" data-dictid=\"44e9c0bbec169277719829907370ee\">sheath</span> and supplied by the <span class=\"customMeta\" data-dictid=\"46ff8ef1ee16927771996bb1697129\">subcostal</span> nerve (T12).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Rectus abdominis muscle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Receives <span class=\"customMeta\" data-dictid=\"6c572343621692777198867cf8d853\">segmental</span> <span class=\"customMeta\" data-dictid=\"45b8853be116927771901a9ff3eeb2\">innervation</span> from T6–T12.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Transversus abdominis muscle</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Does not <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> wall of the inguinal canal. Contributes to the roof and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> wall. Combines with <span class=\"customMeta\" data-dictid=\"50a310ef2e16927771907de8547137\">internal oblique</span> to <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> the conjoint tendon.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Internal <span class=\"customMeta\" data-dictid=\"dd88c7c9741692777194fe0cc9abaa\">oblique</span> muscle (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Forms parts of the <strong>anterior, roof, and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> walls of the inguinal canal.</strong> Contributes to <span class=\"customMeta\" data-dictid=\"5003148c5116927771853277f6839a\">cremasteric</span> muscle and fascia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>External <span class=\"customMeta\" data-dictid=\"dd88c7c9741692777194fe0cc9abaa\">oblique</span> muscle (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Aponeurosis forms the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> wall of the inguinal <span class=\"customMeta\" data-dictid=\"371930068716927771839cba840631\">canal</span> and the <strong>superficial inguinal ring</strong>. Forms external <span class=\"customMeta\" data-dictid=\"85e718f46f1692777198c656f33992\">spermatic</span> fascia.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p><strong>Internal <span class=\"customMeta\" data-dictid=\"85e718f46f1692777198c656f33992\">spermatic</span> fascia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:bottom\">\n<p>Derived from the <span class=\"customMeta\" data-dictid=\"2c1c83a0da16927772000a37812afc\">transversalis</span> fascia.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Injury at which of the following marked sites causes failure of dorsiflexion?", "options": [{"label": "A", "text": "3", "correct": true}, {"label": "B", "text": "2", "correct": false}, {"label": "C", "text": "1", "correct": false}, {"label": "D", "text": "4", "correct": false}], "correct_answer": "A. 3", "question_images": ["https://image.prepladder.com/notes/lkrLSnIXb9nQddi2VthM1745904830.png"], "explanation_images": ["https://image.prepladder.com/notes/2tls9B13KEv1a23RC0mr1745904831.png", "https://image.prepladder.com/content/hyDCSV8r136MKnKeAtcf1745307432.png", "https://image.prepladder.com/content/hi1J9hkbKhx0hAVsHXPS1745307432.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Sciatic Nerve</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Origin and Course</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>The thickest nerve in the body.</li>\n<li>Arises from the <span class=\"customMeta\" data-dictid=\"9ccb2fd2f31692777201e231bfda74\">ventral</span> <span class=\"customMeta\" data-dictid=\"3a4804f0641692777197a34ddfa236\">rami</span> of L4–S3 <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> nerves.</li>\n<li>Exits the <span class=\"customMeta\" data-dictid=\"c25071fa3816927771955eeaf9d45e\">pelvis</span> through the greater <span class=\"customMeta\" data-dictid=\"1cb6159469169277719843ab627a07\">sciatic</span> <span class=\"customMeta\" data-dictid=\"9f027343dd16927772039cf6b0c8e4\">foramen</span> below the piriformis and descends between the <span class=\"customMeta\" data-dictid=\"ff2029fa511692777188fef4dab16c\">greater trochanter</span> and <span class=\"customMeta\" data-dictid=\"634b843bb616927771902f143267c0\">ischial</span> <span class=\"customMeta\" data-dictid=\"3292cfbbdb169277720182a7b986e4\">tuberosity</span> along the back of the thigh.</li>\n<li>Divides into the<strong> <span class=\"customMeta\" data-dictid=\"f2a519f38316927772004fe7c606af\">tibial</span> and common <span class=\"customMeta\" data-dictid=\"1e6451edc31692777195c54367b1ad\">peroneal</span> nerves</strong> above the popliteal fossa.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Distribution</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Motor:</strong></p>\n<ul>\n<li><strong>Undivided Trunk:</strong> Supplies all muscles of the back of the thigh (hip extension, knee flexion).</li>\n<li><strong>Tibial Nerve: </strong>Innervates leg muscles (flexion) and foot muscles (plantar flexion).</li>\n<li><strong>Common <span class=\"customMeta\" data-dictid=\"1e6451edc31692777195c54367b1ad\">Peroneal</span> Nerve:</strong> Supplies leg muscles (dorsiflexion).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sensory:</strong></p>\n<ul>\n<li><strong>Tibial Nerve:</strong> Supplies skin on the back of the calf, heel, <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> border of the foot, and sole.</li>\n<li><strong>Common <span class=\"customMeta\" data-dictid=\"1e6451edc31692777195c54367b1ad\">Peroneal</span> Nerve: </strong>Supplies skin on the <span class=\"customMeta\" data-dictid=\"5a5df583551692777181550518132c\">anterolateral</span> and <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> surfaces of the leg and <span class=\"customMeta\" data-dictid=\"f61866c72d169277718680f9c96ff2\">dorsum</span> of the foot (except for the deep <span class=\"customMeta\" data-dictid=\"1e6451edc31692777195c54367b1ad\">peroneal</span> nerve area).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Clinical correlation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Injury of the <span class=\"customMeta\" data-dictid=\"1cb6159469169277719843ab627a07\">sciatic</span> nerve:</strong></p>\n<ul>\n<li>Causes: Penetrating wounds, <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> hip dislocation, <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> fractures, total hip replacement, misplaced injections in the <span class=\"customMeta\" data-dictid=\"6df580322e1692777188d0c52e5f90\">gluteal</span> region.</li>\n<li>Clinical Features:\n\t\t\t\t<ul>\n<li>Inability to extend the thigh and <span class=\"customMeta\" data-dictid=\"73eb6a06aa1692777202a9f27fafa2\">flex</span> the knee (hamstring paralysis).</li>\n<li>Loss of all movements below the knee (foot drop) leading to <span class=\"customMeta\" data-dictid=\"3dec14fe921692777202dc55958a46\">flail</span> foot and high-stepping gait.</li>\n<li>Loss of sensation on the back of the thigh, entire leg, and foot (except for the saphenous nerve area).</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sciatica:</strong></p>\n<ul>\n<li>Shooting pain along the <span class=\"customMeta\" data-dictid=\"1cb6159469169277719843ab627a07\">sciatic</span> nerve distribution (buttock, <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> thigh, <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> leg, <span class=\"customMeta\" data-dictid=\"f61866c72d169277718680f9c96ff2\">dorsum</span> of the foot).</li>\n</ul>\n<ul>\n<li>Compression/irritation of L4–S3 <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> <span class=\"customMeta\" data-dictid=\"64d06f977116927771936e3af9572f\">nerve roots</span> due to <span class=\"customMeta\" data-dictid=\"18b73c28601692777188f2aae28838\">herniated</span> <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">lumbar</span> discs.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Neuropathy:</strong></p>\n<ul>\n<li>Entrapment in the <span class=\"customMeta\" data-dictid=\"5eb956c3e316927771959407683905\">piriformis muscle</span> can lead to piriformis syndrome.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A schizophrenic patient was prescribed drug A after he did not respond to haloperidol and thioridazine. He now presents with excessive salivation, an increase in blood glucose, and hyperlipidemia. What is drug “A”?", "options": [{"label": "A", "text": "Ziprasidone", "correct": false}, {"label": "B", "text": "Risperidone", "correct": false}, {"label": "C", "text": "Clozapine", "correct": true}, {"label": "D", "text": "Aripiprazole", "correct": false}], "correct_answer": "C. Clozapine", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Clozapine</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Class </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Atypical <span class=\"customMeta\" data-dictid=\"4123308aeb1692777181e8820312dd\">antipsychotic</span> (1<sup>st</sup> <span class=\"customMeta\" data-dictid=\"06123ff61a1692777182e19b790ebc\">atypical</span> <span class=\"customMeta\" data-dictid=\"4123308aeb1692777181e8820312dd\">antipsychotic</span> discovered)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mechanism of action </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Primarily works as a <strong>dopamine D2 <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antagonist</strong>, but it also has significant effects on <span class=\"customMeta\" data-dictid=\"06eba971ce169277719884f8c62937\">serotonin</span> receptors (<strong>5-HT2A</strong> and 5-HT2C), which helps reduce symptoms in treatment-resistant cases.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Uses </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>DOC for TRS (Treatment-resistant schizophrenia): Used only when a patient doesn't respond to at least 2 antipsychotics.</li>\n<li>Only antipsychotics with anti-suicidal properties (shown ↓ suicidal ideas in <span class=\"customMeta\" data-dictid=\"d844b672a616927771988fee71197b\">Schizophrenia</span> patients).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Side effects </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Severe risks (Pneumonic: SAM):</strong></p>\n<ul>\n<li><strong>S -</strong> <strong>Seizures</strong>\n<ul>\n<li>Dose dependant</li>\n<li>&gt; 600 mg has more seizures</li>\n</ul>\n</li>\n<li><strong>A - </strong><strong>Agranulocytosis</strong>\n<ul>\n<li>Idiosyncratic</li>\n<li>↓ <span class=\"customMeta\" data-dictid=\"09be7d1f11169277720210bf5b0280\">WBC</span> (Neutrophils)</li>\n<li>The main reason for deaths and withdrawal from the market</li>\n<li>Weekly monitoring of <span class=\"customMeta\" data-dictid=\"09be7d1f11169277720210bf5b0280\">WBC</span> and <span class=\"customMeta\" data-dictid=\"000d23188716927771936c5f2fe74e\">Neutrophil</span> count for 1<sup>st</sup> 6 months is important</li>\n</ul>\n</li>\n<li><strong>M -</strong><strong> Myocarditis</strong>\n<ul>\n<li>Idiosyncratic</li>\n<li>Chest pain</li>\n<li>Dyspnea</li>\n<li>Abnormal ECG</li>\n</ul>\n</li>\n</ul>\n<p><strong>Common side effects:</strong></p>\n<ul>\n<li>Sedation (most common)</li>\n<li>Weight gain (maximum weight gain of all antipsychotics)</li>\n<li>Hypersalivation (sialorrhea)</li>\n<li>Sedation</li>\n<li>Tachycardia</li>\n<li>Nausea</li>\n<li>Vomiting</li>\n<li>Constipation</li>\n<li>Hypotension</li>\n</ul>\n<p><strong>Rare side effects</strong> include myocarditis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Contraindications </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>WBC count - &lt; 3500/mm</li>\n<li>Previous <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> disorder</li>\n<li>H/o of <span class=\"customMeta\" data-dictid=\"9bf0ef913e1692777180c5783a56a0\">Agranulocytosis</span> during <span class=\"customMeta\" data-dictid=\"8c874bfc1a16927771841a8ad37271\">Clozapine</span> treatment</li>\n<li>Use of another <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> <span class=\"customMeta\" data-dictid=\"f0458fc52216927771996d276de3c4\">suppressant</span> (carbamazepine)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Monitoring </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>TLC and ANC</p>\n<ul>\n<li>Once a week for the first 6 months</li>\n<li>Once in two weeks for the next 6 months</li>\n<li>Once a month till the patient continues</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient comes to the casualty with consumption of OPC pesticide. He was started on IV atropine infusion and pralidoxime. After 2 hours, the patient had a sudden rise in temperature. What is the cause of the fever?", "options": [{"label": "A", "text": "Atropine toxicity", "correct": true}, {"label": "B", "text": "A side effect of pralidoxime", "correct": false}, {"label": "C", "text": "Due to organophosphate poisoning", "correct": false}, {"label": "D", "text": "Idiopathic", "correct": false}], "correct_answer": "A. Atropine toxicity", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - &lt;span class=\"customMeta\" data-dictid=\"90b10f842b1692777182e4a9268284\"&gt;Atropine&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most probable diagnosis for a woman who is experiencing tearfulness, mood swings, and occasional insomnia and is 4 days postpartum?", "options": [{"label": "A", "text": "Postpartum depression", "correct": false}, {"label": "B", "text": "Postpartum blues", "correct": true}, {"label": "C", "text": "Postpartum psychosis", "correct": false}, {"label": "D", "text": "Postpartum anxiety", "correct": false}], "correct_answer": "B. Postpartum blues", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/YJrYtprXzZo6FczMIibO1745307899.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Postpartum Blues</strong></p>\n<p style=\"text-align:center\"><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Postpartum Depression</strong><strong> </strong></p>\n<p style=\"text-align:center\"><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Postpartum Psychosis</strong></p>\n<p style=\"text-align:center\"><strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Timing </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Onset 3-5 days postpartum, resolves by days to weeks.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Within the first 6 weeks <span class=\"customMeta\" data-dictid=\"3d885759d516927771966b84bfa470\">postpartum</span> or after abortion.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Symptoms appear within 2-3 weeks <span class=\"customMeta\" data-dictid=\"3d885759d516927771966b84bfa470\">postpartum</span> and last 2-3 months.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptoms </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Transient symptoms such as:</p>\n<ul>\n<li>Emotionally labile</li>\n<li>Insomnia</li>\n<li>Weepiness/tearfulness</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Loss of energy</li>\n<li>Depressed mood</li>\n<li>Loss of interest or pleasure (anhedonia)</li>\n<li>Loss of appetite</li>\n<li>Insomnia</li>\n<li>Social withdrawal</li>\n<li>Irritability</li>\n<li>Suicidal thoughts</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Initial symptoms: insomnia, tearfulness, mood lability, fatigue, followed by:</p>\n<ul>\n<li>Hallucinations</li>\n<li>Delusions</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Risk Factors </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Not specific; <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to biochemical changes.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Young <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> age</li>\n<li>Antenatal depression</li>\n<li>Family history of mood disorder</li>\n<li>Unmarried status</li>\n<li>Smoking</li>\n<li>Stress</li>\n<li>Newborns in <span class=\"customMeta\" data-dictid=\"901bf573f216927771905f0abedca2\">intensive</span> care</li>\n<li>Physical or verbal abuse</li>\n<li>Serious adverse obstetrical events</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Nulliparas</li>\n<li>Obstetrical complications</li>\n<li>Family history of mood disorder</li>\n<li>History of <span class=\"customMeta\" data-dictid=\"23702653681692777196e5c0fc63cd\">psychotic</span> illness</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Supportive treatment and reassurance.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Antidepressants and psychotherapy.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Hospitalization, pharmacological treatment (lithium, antipsychotics, antidepressants), and long-term psychiatric care.</li>\n<li>Temporary separation from the infant and <span class=\"customMeta\" data-dictid=\"6f686e0c91169277719346f95361c8\">nursing</span> supervision may be necessary.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The mechanism of action of tissue plasminogen activator is:", "options": [{"label": "A", "text": "Inhibit extrinsic pathway", "correct": false}, {"label": "B", "text": "Inhibits platelet aggregation", "correct": false}, {"label": "C", "text": "Enhance fibrin degradation", "correct": true}, {"label": "D", "text": "Inhibit clot formation", "correct": false}], "correct_answer": "C. Enhance fibrin degradation", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/UMCrmvHcypVLhWedSk7X1745908352.png"], "explanation": "<p>Correct Answer C - Enhance &lt;span class=\"customMeta\" data-dictid=\"18c2380be716927772020c9b2863de\"&gt;fibrin&lt;/span&gt; deg\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented with anxiety, restlessness, tremors and fever. His BP is 180/110 mmHg and atrial fibrillation is detected on ECG. He also has a history of asthma. What drug should be given next?", "options": [{"label": "A", "text": "Esmolol", "correct": false}, {"label": "B", "text": "Propranolol", "correct": false}, {"label": "C", "text": "PTU", "correct": false}, {"label": "D", "text": "Diltiazem", "correct": true}], "correct_answer": "D. Diltiazem", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - D\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient was started on dialysis, and he developed disequilibrium. Which of the following drugs should be started?", "options": [{"label": "A", "text": "Ethacrynic acid", "correct": false}, {"label": "B", "text": "Mannitol", "correct": true}, {"label": "C", "text": "Bumetanide", "correct": false}, {"label": "D", "text": "Nesiritide", "correct": false}], "correct_answer": "B. Mannitol", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - M\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What non-pharmacological measures can be recommended to a middle-aged man who experiences premature ejaculation during intercourse?", "options": [{"label": "A", "text": "Cognitive behavioural therapy", "correct": false}, {"label": "B", "text": "Exposure and Response Prevention Therapy", "correct": false}, {"label": "C", "text": "Squeeze technique", "correct": true}, {"label": "D", "text": "Sensate focus therapy", "correct": false}], "correct_answer": "C. Squeeze technique", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/EZdEbfj8AaFwA80Q7wK11745308621.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a 25-year-old woman who presents with symptoms such as anxiety, palpitations, sweating, breathlessness, chest pain, and a sense of impending doom? The patient mentions having encountered approximately 5-6 comparable episodes in the last half-year, with each episode persisting for around 20-30 minutes.", "options": [{"label": "A", "text": "Depression", "correct": false}, {"label": "B", "text": "Panic disorder", "correct": true}, {"label": "C", "text": "Generalized anxiety disorder", "correct": false}, {"label": "D", "text": "Phobia", "correct": false}], "correct_answer": "B. Panic disorder", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Unknown fruit consumption by a child, odd behaviour, fever and low urine output. Causative fruit and treatment is:", "options": [{"label": "A", "text": "Datura - PAM", "correct": false}, {"label": "B", "text": "Datura - Physostigmine", "correct": true}, {"label": "C", "text": "Yellow oleander - Digibind", "correct": false}, {"label": "D", "text": "Yellow oleander - Physostigmine", "correct": false}], "correct_answer": "B. Datura - Physostigmine", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/In4w4teMAWqJ8aoUCHuA1745308895.png"], "explanation": "<p>Correct Answer B) Datura - Physostig\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for a chronic alcoholic who arrives at the emergency department presenting confusion, ataxia, painful eye movements, and involvement of the 6 th cranial nerve?", "options": [{"label": "A", "text": "Wernicke's encephalopathy", "correct": true}, {"label": "B", "text": "Korsakoff's psychosis", "correct": false}, {"label": "C", "text": "Delirium tremens", "correct": false}, {"label": "D", "text": "De Clerambault syndrome", "correct": false}], "correct_answer": "A. Wernicke's encephalopathy", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Wernicke's Encephalopathy</strong></p>\n<p style=\"text-align: center;\"><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Korsakoff Syndrome</strong></p>\n<p style=\"text-align: center;\"><strong>(Option B ruled out)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acute</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chronic, often follows Wernicke's</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Global Confusion</strong></li>\n<li>Ocular abnormalities (nystagmus, gaze palsy)</li>\n<li>Ataxia (especially gait)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Severe <span class=\"customMeta\" data-dictid=\"6f04a43a8c16927771816dd61a4f17\">anterograde</span> amnesia</li>\n<li>Retrograde amnesia</li>\n<li>Confabulation (in some cases)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Thiamine deficiency</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Prolonged <span class=\"customMeta\" data-dictid=\"b70d1dbde516927772000d7774d2a5\">thiamine</span> deficiency</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neuropathological lesions</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Symmetrical and paraventricular, involving <span class=\"customMeta\" data-dictid=\"06d33302e016927771911f7ef71255\">mammillary</span> bodies, thalamus, hypothalamus, midbrain, pons, medulla, fornix, and cerebellum</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Immediate IV thiamine</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Long-term <span class=\"customMeta\" data-dictid=\"b70d1dbde516927772000d7774d2a5\">thiamine</span> supplementation, supportive care</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Potentially <span class=\"customMeta\" data-dictid=\"a4488d66fc16927771975d043c4ccc\">reversible</span> with prompt treatment</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Often irreversible, only about 20% recover</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A colonoscopy of an elderly patient revealed brownish-pigmented lesions. The patient admitted to chronic laxative abuse. Which of the following laxatives is most likely to cause this condition?", "options": [{"label": "A", "text": "Bran", "correct": false}, {"label": "B", "text": "Psyllium", "correct": false}, {"label": "C", "text": "Senna", "correct": true}, {"label": "D", "text": "Methylcellulose", "correct": false}], "correct_answer": "C. Senna", "question_images": ["https://image.prepladder.com/content/8f7zQYOHk7v5TokxHokd1745309230.png"], "explanation_images": [], "explanation": "<p>Correct Answer C - S\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Antibiotics to use for procedures done on cardiac patients:", "options": [{"label": "A", "text": "Cefazolin", "correct": true}, {"label": "B", "text": "Azithromycin", "correct": false}, {"label": "C", "text": "Penicillin", "correct": false}, {"label": "D", "text": "Doxycycline", "correct": false}], "correct_answer": "A. Cefazolin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - &lt;span class=\"customMeta\" data-dictid=\"74e05b271916927771848ff58d86f9\"&gt;Cefazolin&lt;/span&g\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>1st gen</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>2nd gen</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>3rd gen</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>4th gen</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>5th gen</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Cephazolin</li>\n<li>Cephalexin</li>\n<li>Cefadroxil</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Cefuroxime</li>\n<li>Cefoxitin</li>\n<li>Cefaclor</li>\n<li>Cefprozil</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Cefotaxime</li>\n<li>Ceftizoxime</li>\n<li>Ceftriaxone</li>\n<li>Ceftazidime</li>\n<li>Cefpodoxime proxetil</li>\n<li>Cefdinir</li>\n<li>Ceftibuten</li>\n<li>Ceftamet pivoxil</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Cefepime</li>\n<li>Cefpirome</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Ceftaroline</li>\n<li>Ceftobiprole</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is true regarding the Mendelian mode of inheritance?", "options": [{"label": "A", "text": "2/3 rd of Mendelian disorders are autosomal dominant", "correct": true}, {"label": "B", "text": "1/3rd of Mendelian disorders are autosomal recessive", "correct": false}, {"label": "C", "text": "Every 5 th patient has an X-linked recessive disorder", "correct": false}, {"label": "D", "text": "Every 10 th patient has a Y-linked disorder", "correct": false}], "correct_answer": "A. 2/3 rd of Mendelian disorders are autosomal dominant", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:480px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>65% of <span class=\"customMeta\" data-dictid=\"534a300a2c169277719290ac7aa1bf\">mendelian</span> disorders are autosomal dominant</strong></li>\n<li>25% are autosomal <span class=\"customMeta\" data-dictid=\"d54db2110416927771971e7c011a9f\">recessive</span> <strong>(Option B)</strong></li>\n<li>5% are <span class=\"customMeta\" data-dictid=\"dd35346fc716927772029e2f0bb10f\">X-linked</span> <strong>(Option C)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A student had his jaw locked while yawning. Which of the following muscles attached to the articular disc of the temporomandibular joint is under spasmodic contraction?", "options": [{"label": "A", "text": "Lateral pterygoid", "correct": true}, {"label": "B", "text": "Temporalis", "correct": false}, {"label": "C", "text": "Medial pterygoid", "correct": false}, {"label": "D", "text": "Masseter", "correct": false}], "correct_answer": "A. Lateral pterygoid", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The given histology image is of?", "options": [{"label": "A", "text": "Leydig cells of testis", "correct": false}, {"label": "B", "text": "Pancreatic islet cells", "correct": false}, {"label": "C", "text": "Hassall's corpuscles", "correct": false}, {"label": "D", "text": "Glomerulus", "correct": true}], "correct_answer": "D. Glomerulus", "question_images": ["https://image.prepladder.com/notes/zGuB8S2Q28JuyG7I6GFt1745904836.png"], "explanation_images": ["https://image.prepladder.com/notes/swHqTfDVl6vWuObugM6y1745904840.png", "https://image.prepladder.com/notes/NANfioOnNxxC2DPciRW31745905170.png", "https://image.prepladder.com/notes/7U75xuPYXMdRHlZs8la91745905175.png", "https://image.prepladder.com/notes/YC7w6aK83M0ZEZWeChJc1745905178.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A defect in which of the following pharyngeal arch artery causes the defect shown in the image?", "options": [{"label": "A", "text": "Right 4th arch artery", "correct": false}, {"label": "B", "text": "Left 4th arch artery", "correct": false}, {"label": "C", "text": "Right 6th arch artery", "correct": false}, {"label": "D", "text": "Left 6th arch artery", "correct": true}], "correct_answer": "D. Left 6th arch artery", "question_images": ["https://image.prepladder.com/notes/3NAs5e3QaitIZJRyt1gi1745905179.png"], "explanation_images": ["https://image.prepladder.com/content/FpLsZ4PAYTb7UoCUCTmY1745313389.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Pharyngeal Arch</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Artery of Arch</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>First</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Maxillary artery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Second</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hyoid artery, Stapedial artery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Third</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Common <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> artery, Internal <span class=\"customMeta\" data-dictid=\"8593e48e0416927771834eaedb0bfd\">carotid</span> artery</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fourth</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Arch of <span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\">aorta</span> (left side), Subclavian <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> (right side)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sixth</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Ductus arteriosus (left side)</strong>, <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> (right side)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following structures develops from the structure marked?", "options": [{"label": "A", "text": "Medial umbilical ligament", "correct": false}, {"label": "B", "text": "Median umbilical ligament", "correct": true}, {"label": "C", "text": "Meckel's diverticulum", "correct": false}, {"label": "D", "text": "Ligamentum teres", "correct": false}], "correct_answer": "B. Median umbilical ligament", "question_images": ["https://image.prepladder.com/notes/0zxf4r9d4Vhu30s8ZEdO1745905181.png"], "explanation_images": ["https://image.prepladder.com/notes/vQ4bQaf2Sv63RwsJ8HBw1745905182.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Fetal Structure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Postnatal derivative</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Notes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Ductus arteriosus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Ligamentum arteriosum</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Near the left <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> laryngeal nerve</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Ductus venosus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Ligamentum venosum</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Foramen ovale</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Fossa ovalis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Allantois → urachus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Median <span class=\"customMeta\" data-dictid=\"9cc3973459169277720194a0847477\">umbilical</span> ligament</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Urachus is part of <span class=\"customMeta\" data-dictid=\"774591ced216927771818e2164a9ec\">allantois</span> between <span class=\"customMeta\" data-dictid=\"e6cfda323816927771839cc83e376d\">bladder</span> and umbilicus</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Umbilical arteries</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Medial <span class=\"customMeta\" data-dictid=\"9cc3973459169277720194a0847477\">umbilical</span> ligaments</p>\n<p><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>-</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Umbilical vein</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Ligamentum <span class=\"customMeta\" data-dictid=\"8ad930500b1692777200545684a556\">teres</span> hepatis (round ligament)</p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Contained in <span class=\"customMeta\" data-dictid=\"4495d21f7716927772028e313cdedc\">falciform</span> ligament</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with a medical history of liver cirrhosis now presents with abdominal pain, jaundice, and portal hypertension. Anastomosis between which of the following veins will be seen?", "options": [{"label": "A", "text": "Left colic vein and middle colic veins", "correct": false}, {"label": "B", "text": "Esophageal veins and left gastric veins", "correct": true}, {"label": "C", "text": "Superior and phrenic veins", "correct": false}, {"label": "D", "text": "Sigmoid and superior rectal veins", "correct": false}], "correct_answer": "B. Esophageal veins and left gastric veins", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Site of anastomosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Veins forming portocaval anastomosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clinical signs</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lower third of the esophagus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Left <span class=\"customMeta\" data-dictid=\"12347b15191692777188bc86d226e1\">gastric</span> vein</p>\n<p style=\"text-align: center;\">↑ ↓</p>\n<p style=\"text-align: center;\">Esophageal veins draining into <span class=\"customMeta\" data-dictid=\"9e415033a51692777182914ea1a92e\">azygos</span> vein</p>\n<p style=\"text-align: center;\"> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Esophageal varices</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Umbilicus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Paraumbilical veins</p>\n<p style=\"text-align: center;\">↑↓</p>\n<p style=\"text-align: center;\">Superficial veins of <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> wall</p>\n<p style=\"text-align: center;\"> </p>\n<p style=\"text-align: center;\"> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Caput medusae</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mid-anal canal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Superior rectal vein</p>\n<p style=\"text-align: center;\">↑↓</p>\n<p style=\"text-align: center;\">Middle and <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> rectal veins</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hemorrhoids</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child presents with intermittent jaundice and splenomegaly. There is a history of similar complaints in the elder brother. A peripheral smear shows the following findings. Which of the following is the most appropriate diagnostic test for this condition?", "options": [{"label": "A", "text": "Osmotic fragility test - Hereditary spherocytosis", "correct": true}, {"label": "B", "text": "Coombs test - Autoimmune hemolytic anaemia", "correct": false}, {"label": "C", "text": "Genetic testing - G6PD deficiency", "correct": false}, {"label": "D", "text": "Flow cytometry - Paroxysmal nocturnal hemoglobinuria", "correct": false}], "correct_answer": "A. Osmotic fragility test - Hereditary spherocytosis", "question_images": ["https://image.prepladder.com/content/3fNAfCZpf8Ez8JhQKZ2H1745313411.png"], "explanation_images": ["https://image.prepladder.com/content/6icA1Y47wSZeEkq3qvH21745313493.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:NaN\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Mutations of <strong>ankyrin, band 3, spectrin, or band 4.2</strong></p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\">Unstable RBC <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> with <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> loss</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\">The surface: volume ratio is reduced</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\">RBC takes up the shape of a sphere to compensate</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\">Spherical RBCs are trapped in splenic sinusoids due to large size</p>\n<p style=\"text-align:center\">↓</p>\n<p style=\"text-align:center\">Extravascular hemolysis</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with swelling under the left ear lobule and complains of pain. Which of the following structures is the likely cause of the pain?", "options": [{"label": "A", "text": "Facial nerve", "correct": false}, {"label": "B", "text": "Greater auricular nerve", "correct": true}, {"label": "C", "text": "Auriculotemporal nerve", "correct": false}, {"label": "D", "text": "Investing layer of deep cervical fascia", "correct": false}], "correct_answer": "B. Greater auricular nerve", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/stoV2x6qJ24T6i8t9UhO1745313940.png", "https://image.prepladder.com/content/OMAPfbQKk7wcCGmsNkk41745313940.png", "https://image.prepladder.com/content/A6cLp32P2T2YkfkQV4Ca1745313940.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:623px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Aspects</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Auricle (Pinna)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>External Auditory Meatus</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Composition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elastic cartilage, except <span class=\"customMeta\" data-dictid=\"633bbec0f916927771913a073bbea5\">lobule</span> (fibrofatty tissue)</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Cartilaginous part (Outer 1/3)</strong> with hair and ceruminous glands</li>\n<li><strong>Bony part (Inner 2/3),</strong> with thin skin continuous with the <span class=\"customMeta\" data-dictid=\"391176370016927772011d1b8315bc\">tympanic</span> membrane, lacks hair and glands.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Parts</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Concha </strong>(Depression leading to the external meatus)</li>\n<li><strong>Helix</strong> (Prominent rim with <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> limbs)</li>\n<li><strong>Antihelix (</strong>Parallel ridge to the helix)</li>\n<li><strong>Tragus &amp; Antitragus</strong> (Separated by inter-tragic notch)</li>\n<li><strong>Cymba Conchae</strong> (Above <span class=\"customMeta\" data-dictid=\"653381031a1692777185f2d7287a66\">crus</span> of helix)</li>\n<li><strong>Lobule</strong> (Soft, <span class=\"customMeta\" data-dictid=\"384d0cc3641692777202e927a4d222\">fleshy</span> part below antitragus)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Nerve Supply </strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lateral Surface</strong></p>\n<ul>\n<li>Lower third: <strong>Great <span class=\"customMeta\" data-dictid=\"e825a1e928169277718206e4709c41\">auricular</span> nerve (C2, C3)</strong></li>\n<li>Upper two-thirds:<strong> Auriculotemporal nerve (CN V3)</strong></li>\n<li>Concha:<strong> <span class=\"customMeta\" data-dictid=\"e825a1e928169277718206e4709c41\">Auricular</span> branch of <span class=\"customMeta\" data-dictid=\"c8da04ed171692777201da65246acd\">vagus</span> (CN X) (Alderman’s Nerve)</strong></li>\n</ul>\n<p> </p>\n<p><strong>Medial Surface</strong></p>\n<ul>\n<li>Lower third: <strong>Great <span class=\"customMeta\" data-dictid=\"e825a1e928169277718206e4709c41\">auricular</span> nerve</strong></li>\n<li>Upper two-thirds:<strong> Lesser <span class=\"customMeta\" data-dictid=\"77dc7a0ab81692777194dba7ab78ab\">occipital</span> nerve (C2)</strong></li>\n</ul>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Roof &amp; <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">Anterior</span> Wall: </strong>Auriculotemporal nerve (CN V3)</li>\n<li><strong>Floor &amp; <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">Posterior</span> Wall: </strong>Auricular branch of <span class=\"customMeta\" data-dictid=\"c8da04ed171692777201da65246acd\">vagus</span> (CN X)</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Relevance</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>McEwen’s <span class=\"customMeta\" data-dictid=\"d398f22bb71692777201622867bda7\">triangle</span> (Cymba Conchae)</p>\n<ul>\n<li>It is a <span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\">surgical</span> landmark on the <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> bone to locate the <span class=\"customMeta\" data-dictid=\"a59fda103116927771912d5d76d293\">mastoid</span> antrum.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Furuncles (cartilaginous part) <span class=\"customMeta\" data-dictid=\"55691242bb1692777199360f64cb67\">susceptible</span> to infections</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An African child is found to have a mass in the jaw. A biopsy of the mass was done, and it appears as shown in the image below. The child also has a translocation, t(8;14). What is the probable diagnosis?", "options": [{"label": "A", "text": "Acute myeloid leukemia", "correct": false}, {"label": "B", "text": "Follicular lymphoma", "correct": false}, {"label": "C", "text": "Multiple myeloma", "correct": false}, {"label": "D", "text": "Burkitt lymphoma", "correct": true}], "correct_answer": "D. Burkitt lymphoma", "question_images": ["https://image.prepladder.com/content/kjlo246wR5v4K5GjltED1745313821.png"], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The blood pressure of a population was tracked from childhood to adulthood. It was observed that those who had lower BP in childhood had low BP in adulthood, while those who had higher BP in childhood had high BP in adulthood. This can be best described as:", "options": [{"label": "A", "text": "Rule of halves", "correct": false}, {"label": "B", "text": "Tracking of blood pressure", "correct": true}, {"label": "C", "text": "Stepwise approach", "correct": false}, {"label": "D", "text": "Primordial approach", "correct": false}], "correct_answer": "B. Tracking of blood pressure", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/XjzBnUodstMdP99Wm2Oe1745314157.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A pediatric patient presents with cola-coloured urine, high blood pressure, and periorbital oedema. Laboratory tests reveal a creatinine level of 2.5 mg/dL, which rises to 4.5 mg/dL after 3 weeks despite treatment. What electron microscopic finding is most likely in this patient?", "options": [{"label": "A", "text": "Subendothelial deposits", "correct": false}, {"label": "B", "text": "Subepithelial deposits", "correct": true}, {"label": "C", "text": "Crescent formation", "correct": false}, {"label": "D", "text": "Mesangial deposits", "correct": false}], "correct_answer": "B. Subepithelial deposits", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/tEFf36NXnWnVApss1hOF1745314316.png", "https://image.prepladder.com/content/XVlIPEnuB38Fwdx1XP731745314325.png", "https://image.prepladder.com/content/QlIFDeeVWpJC4UWW3htJ1745314334.png", "https://image.prepladder.com/content/uF28BIbk39zlqGDNbK1C1745314342.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Pathological findings in PSGN</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Grossly</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Kidneys appear speckled or <span class=\"customMeta\" data-dictid=\"66f4e1c35716927771929959483274\">mottled</span> due to numerous small haemorrhages <strong>(Flea-bitten appearance)</strong>.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Y. EroksuzM. DabakH. EroksuzE. BaydarI. TurkogluI. Yılmaz\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.semanticscholar.org/paper/Acute-oak-%28-Quercus-infectoria-%29-toxicosis-in-lambs-Eroksuz-Dabak/c5ab82a2c4fec864d015d83681eb6dda8f560591/figure/2\" data-tags=\"\" height=\"300\" src=\"https://image.prepladder.com/content/tEFf36NXnWnVApss1hOF1745314316.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Light microscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypercellular <span class=\"customMeta\" data-dictid=\"c9bd75ce5f1692777188f7fe800061\">glomeruli</span> </strong>are caused by <span class=\"customMeta\" data-dictid=\"669bdcb3111692777190e018ae930e\">infiltration</span> by leukocytes (neutrophils and monocytes) and the<strong> </strong><strong>proliferation of endothelial and mesangial cells</strong><strong>. </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Electron microscope</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>‘Subepithelial <span class=\"customMeta\" data-dictid=\"3012715fa81692777187f57c5a2b0e\">electron-dense</span> humps’</strong><strong> </strong>due to immune complex deposition beneath the epithelial cells of the <span class=\"customMeta\" data-dictid=\"1ad1e71a4a1692777188853097f685\">glomerular</span> basement membrane.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Alejandro Best\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.arkanalabs.com/subepithelial-humps/\" data-tags=\"\" height=\"311\" src=\"https://image.prepladder.com/content/XVlIPEnuB38Fwdx1XP731745314325.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Immunofluorescence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Characteristic <strong>'Starry sky appearance'</strong><strong> </strong> by immune complex deposition.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Khalighi, Mazdak &amp; Wang, Shihtien &amp; Henriksen, Kammi &amp; Bock, Margret &amp; Keswani, Mahima &amp; Meehan, Shane &amp; Chang, Anthony.\" data-hash=\"\" data-license=\"CC BY NC 4.0\" data-source=\"https://www.researchgate.net/publication/303363829_Revisiting_post-infectious_glomerulonephritis_in_the_emerging_era_of_C3_glomerulopathy?_tp=eyJjb250ZXh0Ijp7ImZpcnN0UGFnZSI6Il9kaXJlY3QiLCJwYWdlIjoiX2RpcmVjdCJ9fQ\" data-tags=\"\" height=\"241\" src=\"https://image.prepladder.com/content/QlIFDeeVWpJC4UWW3htJ1745314334.png\" width=\"500\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the condition associated with the murmur depicted in the image below.", "options": [{"label": "A", "text": "Mitral Regurgitation", "correct": true}, {"label": "B", "text": "Aortic Regurgitation", "correct": false}, {"label": "C", "text": "Aortic Stenosis", "correct": false}, {"label": "D", "text": "Mitral Stenosis", "correct": false}], "correct_answer": "A. Mitral Regurgitation", "question_images": ["https://image.prepladder.com/content/lb9f2BDgt2we57yuh9zx1745314396.png"], "explanation_images": [], "explanation": "<p>Correct Answer A - &lt;span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\"&gt;Mitral&lt;/span&gt; Regurgitation</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Features of Murmur</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Associated Symptoms</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mitral <span class=\"customMeta\" data-dictid=\"9e495cf9cf16927771975bf315a060\">Regurgitation</span> (MR)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Incomplete <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> of the <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> valve, causing <span class=\"customMeta\" data-dictid=\"bbee2f1b011692777182d9b84068ec\">backflow</span> from LV to LA.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Type: <span class=\"customMeta\" data-dictid=\"529e0aff291692777194cbe766b6de\">Pansystolic</span> murmur.</li>\n<li>Location: Best heard at the apex, radiates to the axilla.</li>\n<li>Intensity: <span class=\"customMeta\" data-dictid=\"d4ae50897e16927771884b5c46ba7d\">Grade</span> II-IV, soft/absent S1 in chronic cases.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dyspnea, fatigue, orthopnea, atrial fibrillation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Aortic <span class=\"customMeta\" data-dictid=\"9e495cf9cf16927771975bf315a060\">Regurgitation</span> (AR) (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Incomplete <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> of the aortic valve, causing <span class=\"customMeta\" data-dictid=\"e38ca8e6931692777197ee6a68ac56\">retrograde</span> flow into LV.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Type: Diastolic decrescendo murmur.</li>\n<li>Location: Best heard at left sternal border (3rd-4th ICS).</li>\n<li>Features: High-pitched, decrescendo.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bounding pulses, wide pulse pressure, Water-Hammer pulse, <span class=\"customMeta\" data-dictid=\"1a5e87d16716927771888f364bce89\">heart failure</span> symptoms.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Aortic Stenosis (AS) (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Narrowing of the aortic valve, obstructing LV outflow.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Type: <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">Systolic</span> <span class=\"customMeta\" data-dictid=\"3b69bda4d21692777187109c85a27e\">ejection</span> murmur.</li>\n<li>Location: Best heard at right upper sternal border (2nd ICS), radiates to carotids.</li>\n<li>Features: Crescendo-decrescendo.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Angina, syncope, left <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> hypertrophy, <span class=\"customMeta\" data-dictid=\"5b09a1161b169277719460978e4cc1\">paradoxical</span> S2 splitting.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mitral Stenosis (MS) (Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Narrowing of the <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> valve, obstructing flow from LA to LV.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Type: Diastolic rumbling murmur.</li>\n<li>Location: Best heard at <span class=\"customMeta\" data-dictid=\"2d7ea2751316927771816ceb31afee\">apex</span> in left <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"f518295be51692777185698bd9b0fd\">decubitus</span> position.</li>\n<li>Features: Low-pitched, with an <span class=\"customMeta\" data-dictid=\"bcee4434ec169277719487e088cf42\">opening snap</span> after S2.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dyspnea, <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> hypertension, right-sided heart failure, atrial fibrillation.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Definition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Abnormal <span class=\"customMeta\" data-dictid=\"3ca731b15316927771898437884f89\">heart sounds</span> caused by turbulent <span class=\"customMeta\" data-dictid=\"82cc227a1c169277718387905b50c6\">blood flow</span> through valves or <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> chambers.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Systolic Murmurs:</strong> Occur between S1 and S2 (e.g., MR, AS).</li>\n<li><strong>Diastolic Murmurs: </strong>Occur between S2 and S1 (e.g., MS, AR).</li>\n<li><strong>Continuous Murmurs:</strong> Occur throughout the <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> cycle (e.g., PDA).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Assessment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Includes <span class=\"customMeta\" data-dictid=\"da6b4ea38d169277719384b53c8f45\">murmur</span> timing, intensity, location, radiation, and associated <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> or <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> features.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Grading System (Intensity)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Grade I:</strong> Barely audible.</li>\n<li><strong>Grade II: </strong>Soft but easily audible.</li>\n<li><strong>Grade III: </strong>Loud without thrill.</li>\n<li><strong>Grade IV:</strong> Loud with a <span class=\"customMeta\" data-dictid=\"bd478e4ff816927771949528846af9\">palpable</span> thrill.</li>\n<li><strong>Grade V:</strong> Very loud, audible with edge of stethoscope.</li>\n<li><strong>Grade VI:</strong> Audible without a stethoscope.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 48-year-old man presents with facial puffiness, frothy urine, hypertension, a history of hepatitis B infection, and microscopic hematuria. A kidney biopsy reveals a spike and dome pattern. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Minimal change disease", "correct": false}, {"label": "B", "text": "Membranous nephropathy", "correct": true}, {"label": "C", "text": "Focal segmental glomerulosclerosis", "correct": false}, {"label": "D", "text": "PSGN-associated disease", "correct": false}], "correct_answer": "B. Membranous nephropathy", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ooaVY9vsrr0ahCxeSF4z1745314676.png", "https://image.prepladder.com/content/PN4FDF4TLypIjPLolBcH1745314685.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Pathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Light Microscope</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Electron Microscope</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Immunofluorescence</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Membranous Nephropathy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Diffuse <span class=\"customMeta\" data-dictid=\"89e3252d5b16927771833fb9b432ae\">capillary</span> wall thickening</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Subepithelial deposits</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">Granular <span class=\"customMeta\" data-dictid=\"2d9b37c62116927771891f3784d2c8\">IgG</span> and C3; diffuse</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The years of potential life lost could be attributed to:", "options": [{"label": "A", "text": "Years lost to morbidity", "correct": false}, {"label": "B", "text": "Years lost due to premature death", "correct": true}, {"label": "C", "text": "Years lost to disability", "correct": false}, {"label": "D", "text": "Years lost to poor quality of life", "correct": false}], "correct_answer": "B. Years lost due to premature death", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:775px\">\n<tbody>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Crude death rate</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p>CDR = (Total no. or deaths in a community/ MYP (Mid-year population) in the same area) x 100</p>\n<ul>\n<li>The mid-year population is taken on 1st July</li>\n<li>Limitation: It does not consider the age and sex of the population</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p><strong>Age-specific death rate </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p>ASDR = (Total no. of deaths in a particular age group (eg. 20-24yrs) a given area in a year/ MYP of the age group in the same area and year) x 1000</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p><strong>Expectation of life</strong></p>\n<p> </p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<ul>\n<li>Life <span class=\"customMeta\" data-dictid=\"9332897b901692777187ae9cd44351\">expectancy</span> at birth: A positive mortality indicator· Average no. of years a <span class=\"customMeta\" data-dictid=\"04df903fe8169277719383126b1b02\">newborn</span> is expected to live, considering the current age-specific mortality rates in a community.</li>\n<li>Important component to calculate the Human Development Index (HDI).</li>\n<li>Life <span class=\"customMeta\" data-dictid=\"9332897b901692777187ae9cd44351\">expectancy</span> at one year is PQLI. In 2021, life <span class=\"customMeta\" data-dictid=\"9332897b901692777187ae9cd44351\">expectancy</span> in India is <strong>69.7 years</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p><strong>Infant mortality rate </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p>IMR = (Total number of deaths (0-1-year-old) in a given year / Total number of live births in the same year) x 1000. It is a health status indicator.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p><strong>Under-five mortality rate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p>U5MR = (Total number of deaths (0-5 years old) in a given year /Total number of live births in one year) x 1000</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p><strong>Maternal Mortality Rate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p>Maternal Mortality Rate (MMR) = (Total no. of <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> deaths/women in the <span class=\"customMeta\" data-dictid=\"11e24b369816927771974383c7e17c\">reproductive</span> age group [15-49 years]) x 100,000</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p><strong>Maternal Mortality Ratio (MMR)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p>Maternal Mortality <strong>Ratio </strong>(MMR) = (Total no. of <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> deaths/Live Births) x 100,000</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p><strong>Adult mortality rate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p>Probability of dying between 15 to 60 years of life</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p><strong>Year of potential life lost </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p>Premature death measurement. If life <span class=\"customMeta\" data-dictid=\"9332897b901692777187ae9cd44351\">expectancy</span> is 75 years, and death happens at age 30, then 45 years of potential life is lost</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p><strong>Proportional mortality rate </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p>The simplest measure of the burden of disease (Total deaths due to disease 'x'/ Total deaths in a community)́ x 100</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p><strong>Case fatality rate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p>CFR = (Deaths due to diseases ‘z’ / total no of cases of disease ‘z’) x 100</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:765px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Quality-adjusted Life Years (QALY)</strong></p>\n<p><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<ul>\n<li>Quality and quantity of life lived.</li>\n<li>Assesses number of years of life added due to the intervention and hence the benefit and value for money of the intervention</li>\n<li>QALY - 1 year of life lived in <u>perfect</u> health</li>\n<li>Positive indicator of the cost-effectiveness of an intervention.</li>\n<li>Scored between 0 (death) and 1 (perfect health).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p><strong>Disability-adjusted Life Years (DALY)</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<ul>\n<li>DALY= Years of life lost to <span class=\"customMeta\" data-dictid=\"84f13673191692777196762b18e036\">premature</span> death + years lived with disability</li>\n<li>1 DALY: 1 year of healthy life lost</li>\n<li>It is a measure of the burden of disease and the effectiveness of intervention<br/>\n\t\t\t\t </li>\n</ul>\n<p><strong>Year of life lost (YLL):</strong></p>\n<ul>\n<li>Calculated from the number of deaths at each age multiplied by the expected remaining years of life according to a global standard life expectancy.<br/>\n\t\t\t\t </li>\n</ul>\n<p><strong>Years lost to disability (YLD):</strong></p>\n<ul>\n<li>Where the number of incident cases due to injury and illness is multiplied by the average duration of the disease and a weighting factor reflecting the severity of the disease on a scale from 0 (perfect health) to 1 (dead).</li>\n</ul>\n<p> </p>\n<p><strong>DALY = YLL + YLD</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p><strong>Health Adjusted Life <span class=\"customMeta\" data-dictid=\"9332897b901692777187ae9cd44351\">Expectancy</span> (HALE)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<ul>\n<li>The average number of years a <span class=\"customMeta\" data-dictid=\"04df903fe8169277719383126b1b02\">newborn</span> is expected to live in full health considering the current age-specific mortality rate.<br/>\n\t\t\t\tHealthy Life Expectancy\n\t\t\t\t<ul>\n<li>HALE = Life <span class=\"customMeta\" data-dictid=\"9332897b901692777187ae9cd44351\">Expectancy</span> at birth + adjustment of time spent in poor health</li>\n<li>HALE = LE-DALY</li>\n</ul>\n</li>\n</ul>\n<p><strong>Life Expectancy</strong></p>\n<ul>\n<li>Average no. of years a <span class=\"customMeta\" data-dictid=\"04df903fe8169277719383126b1b02\">newborn</span> is expected to live, considering the current age-specific mortality rate.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p><strong>Sullivan’s index<br/>\n\t\t\t(or DFLE)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<ul>\n<li>Disability-free life <span class=\"customMeta\" data-dictid=\"9332897b901692777187ae9cd44351\">expectancy</span> (DFLE) with the current pattern of mortality and disability.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 5-year-old child presents with fever, fatigue, and left ventricular dysfunction. An endomyocardial biopsy is shown below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Acute rheumatic fever", "correct": false}, {"label": "B", "text": "Chagas cardiomyopathy", "correct": false}, {"label": "C", "text": "Pyogenic myocarditis", "correct": false}, {"label": "D", "text": "Lymphocytic myocarditis", "correct": true}], "correct_answer": "D. Lymphocytic myocarditis", "question_images": ["https://image.prepladder.com/notes/loUHX3atK0fdTinIeW6h1745907694.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young man came to the medical OPD with complaints of early morning backache and stiffness, which improves on exercise, and persistent red eyes. On examination, lung expansion was less than 3 cm. X-ray is shown in the image given below. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Ankylosing Spondylitis", "correct": true}, {"label": "B", "text": "Paget's Disease", "correct": false}, {"label": "C", "text": "Healed Tuberculosis", "correct": false}, {"label": "D", "text": "Osteopetrosis", "correct": false}], "correct_answer": "A. Ankylosing Spondylitis", "question_images": ["https://image.prepladder.com/notes/VEvNQU2i9SX7RqmKejsk1745917373.png"], "explanation_images": ["https://image.prepladder.com/notes/P1nRvJi4MIy2pHGUtjOd1745917374.png"], "explanation": "<p>Correct Answer A - Ankylosing Spondylitis</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Ankylosing <span class=\"customMeta\" data-dictid=\"42d4868c2e1692777199353a7ad077\">Spondylitis</span> - Clinical Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>General Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Spine and Joint involvement</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Extra-articular manifestations</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Inflammatory back pain</strong>: <strong>Gradual onset, worse with inactivity, improves with movement</strong> and is often associated with early morning stiffness.</li>\n<li><strong>Fatigue</strong>: A common and significant symptom.</li>\n<li><strong>Postural changes</strong>: Loss of <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">lumbar</span> lordosis, increased <span class=\"customMeta\" data-dictid=\"3c6021096816927772007954fcc158\">thoracic</span> kyphosis, and forward stooping of the neck.</li>\n<li><strong>Enthesitis</strong>: <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">Inflammation</span> at <span class=\"customMeta\" data-dictid=\"606c2acae5169277720052151cb04c\">tendon</span> or <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> <span class=\"customMeta\" data-dictid=\"ccd357daaf16927771825777ea6a0d\">attachment</span> sites, often mistaken for fibromyalgia.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Peripheral joint involvement</strong>: Affects large joints like<strong> hips, knees</strong>, and shoulders and is usually asymmetrical.</li>\n<li><strong>Sacroiliac joint involvement</strong>: B/L and asymmetrical; pain may <span class=\"customMeta\" data-dictid=\"f4a826ea4916927771977e2f55c16f\">radiate</span> to the <span class=\"customMeta\" data-dictid=\"a0af4564cf1692777183e503d226f6\">buttocks</span> or <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> thighs.</li>\n<li><strong>Reduced <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> mobility:</strong> Limited movement in the <span class=\"customMeta\" data-dictid=\"683192f6b21692777191ae16feee76\">lumbar</span> region due to <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and pain, often accompanied by muscle spasms.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Anterior uveitis:</strong> <strong>Most common extra <span class=\"customMeta\" data-dictid=\"cd001152fe16927771823275439a2d\">articular</span> manifestation.</strong> Presents with sudden <span class=\"customMeta\" data-dictid=\"92b4dd0d9516927772013f2e4296b7\">unilateral</span> eye pain, redness, and light sensitivity, often preceding joint symptoms.</li>\n<li>Anaemia, prostatitis, <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> disease, <span class=\"customMeta\" data-dictid=\"59a120854e16927771820318aebd4a\">aortic valve</span> disease, and very rare cases of <span class=\"customMeta\" data-dictid=\"959f3344b116927771815235718f3d\">amyloidosis</span> or upper <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> fibrosis</li>\n<li><strong>Osteoporosis</strong>: This can lead to vertebral fractures, especially with <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> fusion.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Investigations of Ankylosing Spondylitis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>X-rays </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>MRI </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>HLA-B27: </strong>The presence of the HLA-B27 gene is a strong indicator of AS. The <span class=\"customMeta\" data-dictid=\"f86aae0bd61692777196f91458c9dd\">prevalence</span> of AS in the general population is less than 0.5%.</li>\n<li><strong>Inflammatory Markers</strong>: Elevated ESR and CRP levels may indicate active disease.</li>\n<li><strong>Faecal Calprotectin</strong>: Helps screen for associated <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> <span class=\"customMeta\" data-dictid=\"37863e7aec169277718310f33c6a11\">bowel</span> disease.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Show characteristic changes in <strong>sacroiliac joints</strong>, such as:</p>\n<ul>\n<li>Blurred <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> margins</li>\n<li>Erosions and sclerosis</li>\n<li>\"Pseudowidening\" of joint space (early stages)</li>\n<li>Joint space narrowing and <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> (later stages)</li>\n<li><strong>Bamboo spine </strong>- Vertebral body <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> by syndesmophytes</li>\n<li><strong>Dagger sign </strong>- Calcification appears as a single <span class=\"customMeta\" data-dictid=\"418c408a7716927771979034974902\">radiodense</span> line vertically running down the spine on <span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\">frontal</span> radiographs.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Investigation of choice – <strong>more sensitive</strong> than X-rays for detecting early <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> changes.</li>\n<li>Can reveal <span class=\"customMeta\" data-dictid=\"5b9831f3aa169277718395d7361df6\">bone marrow</span> oedema, enthesitis, synovitis, and erosions.</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Radiographic Abnormalities</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Rheumatoid <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">Arthritis</span> (RA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Periarticular osteoporosis, joint subluxation, marginal erosions, joint space narrowing, osteoporosis, osteopenia, and vertebral fractures.</li>\n<li>Ulnar Deviation, <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> of Synovial Tissue</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Paget’s Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Bone expansion, <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> trabecular pattern.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Psoriatic <span class=\"customMeta\" data-dictid=\"6f74c7bfe0169277718240005b59d1\">Arthritis</span> (PsA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Sacroiliitis, syndesmophytes, bone sclerosis.</li>\n<li>Pencil-in-cup deformity</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Osteoarthritis (OA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Joint space narrowing, osteophytes, <span class=\"customMeta\" data-dictid=\"70d8631e3c16927771992f8f444ab1\">subchondral</span> sclerosis, fractures, <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> thinning, osteosclerosis, lysis, pseudofractures, proliferative <span class=\"customMeta\" data-dictid=\"e1f58a43ce169277718758e6f0a08d\">enthesis</span> erosions, enthesophytes, joint deformity, <span class=\"customMeta\" data-dictid=\"70d8631e3c16927771992f8f444ab1\">subchondral</span> cysts.</li>\n<li>Heberden’s Nodes (involvement of DIP), Bouchard’s Nodes (involvement of PIP)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Ankylosing Spondylitis (AS)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Joint fusion, syndesmophytes, sacroiliitis, <span class=\"customMeta\" data-dictid=\"d816ba952f1692777199fc69bd7c56\">spinal</span> <span class=\"customMeta\" data-dictid=\"301e3b01f01692777191aced6dc342\">ligament</span> calcification.</li>\n<li>Bamboo Spine, Shiny Corner Sign, Squaring of Vertebrae</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Systemic Lupus Erythematosus (SLE)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Joint space narrowing, <span class=\"customMeta\" data-dictid=\"b1db3c1e5d1692777195ff7cd3e282\">periarticular</span> osteoporosis, <span class=\"customMeta\" data-dictid=\"70d8631e3c16927771992f8f444ab1\">subchondral</span> cysts, <span class=\"customMeta\" data-dictid=\"a28b336ec21692777183ec0b5e47f9\">calcinosis</span> cutis.</li>\n<li>Destructive arthritis, erosions in later stages.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Gout</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Acute inflammation, joint space narrowing, <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> erosions.</li>\n<li>Tophus (urate crystal deposits in soft tissue).</li>\n<li>Martel G sign: Also known as rat-bite erosions (lytic lesions with <span class=\"customMeta\" data-dictid=\"934e9f88af169277719847f1a0728f\">sclerotic</span> margin &amp; overhanging edge)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Scleroderma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Calcinosis cutis, soft tissue calcifications, joint space narrowing.</li>\n<li>Ray Sign (involvement of small joints of hands).</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An elderly male smoker presents with a chronic cough, significant weight loss, and fatigue. The serum calcium level is raised. A lung biopsy reveals large atypical cells with hyperchromasia. What is the probable diagnosis?", "options": [{"label": "A", "text": "Large cell neuroendocrine tumour", "correct": false}, {"label": "B", "text": "Small cell carcinoma", "correct": false}, {"label": "C", "text": "Adenocarcinoma", "correct": false}, {"label": "D", "text": "Squamous cell carcinoma", "correct": true}], "correct_answer": "D. Squamous cell carcinoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/8BthGWhtUSNH34Qlnvge1745315155.png", "https://image.prepladder.com/notes/EWVBlLT1aYfhaS5564pM1745907698.png", "https://image.prepladder.com/notes/ZiTF1fK7vAtwcEO1mmnQ1745907702.png", "https://image.prepladder.com/notes/lKdLSQ1eTJ8hEZZGqGkM1745907695.png", "https://image.prepladder.com/notes/V4RHyneuNPxRrldB3e4w1745907699.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Type of Lung Carcinoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Paraneoplastic Syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Squamous cell carcinoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hypercalcemia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Adenocarcinoma </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Migratory thrombophlebitis</p>\n<p>(<strong>Trousseau syndrome</strong>)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Small cell or <span class=\"customMeta\" data-dictid=\"3d2453376b16927771947134f6a67d\">oat</span> cell Carcinoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>SIADH (syndrome of inappropriate anti-diuretic hormone secretion)</li>\n<li>Cushing's syndrome</li>\n<li>Lambert Eaton syndrome</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Large cell carcinoma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gynaecomastia</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Characteristic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Small Cell Carcinoma</strong><br/>\n<strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Squamous Cell Carcinoma</strong><br/>\n<strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Carcinoid Tumor </strong><br/>\n<strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Adenocarcinoma</strong><br/>\n<strong>(Option C)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Origin</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Neuroendocrine cells of the lung.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Squamous cells of the lung.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Neuroendocrine cells of bronchial epithelium.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Glandular cells of the lung.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cells in histopathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Small, round to oval, blue cells with <strong>scant cytoplasm</strong><strong> </strong>and finely <span class=\"customMeta\" data-dictid=\"4f63eb15be169277718848d4b4978b\">granular</span> <span class=\"customMeta\" data-dictid=\"77399c6ee0169277718492fb8fd58f\">chromatin</span> with a <strong>“salt and pepper” </strong>appearance.</p>\n<figure class=\"caption_element\"><img alt=\"PPA055\" data-author=\"John K. C. Chan,\" data-hash=\"11368\" data-license=\"NA\" data-source=\"https://journals.sagepub.com/doi/10.1177/1066896913517939?icid=int.sj-full-text.similar-articles.5\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/EWVBlLT1aYfhaS5564pM1745907698.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sheets of polygonal cells with <strong>keratinisation</strong> and <strong>intercellular bridges</strong></p>\n<figure class=\"caption_element\"><img alt=\"PPA057\" data-author=\"Stojsic, Jelena. \" data-hash=\"11370\" data-license=\"CC BY 3.0\" data-source=\"https://www.researchgate.net/figure/Keratinizing-squamous-cell-carcinoma-of-the-lung-H-E-100_fig1_328645447\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/ZiTF1fK7vAtwcEO1mmnQ1745907702.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nesting</strong> (organoid) growth pattern with uniform round nuclei, <strong>moderate <span class=\"customMeta\" data-dictid=\"91bc3a9b3e16927771871bcff74db7\">eosinophilic</span> cytoplasm</strong>, and a <strong>“</strong><strong>salt-and-pepper”</strong> <span class=\"customMeta\" data-dictid=\"77399c6ee0169277718492fb8fd58f\">chromatin</span> pattern.</p>\n<figure class=\"caption_element\"><img alt=\"PPA054\" data-author=\"NA\" data-hash=\"11367\" data-license=\"NA\" data-source=\"https://www.webpathology.com/images/pulmonary/epithelial-lung-tumors/neuroendocrine-tumors/45441\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/lKdLSQ1eTJ8hEZZGqGkM1745907695.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Glandular or epithelial cells forming acinar, papillary, or solid patterns</p>\n<figure class=\"caption_element\"><img alt=\"PPA056\" data-author=\"Michael Yang &amp; Daisuke Nonaka\" data-hash=\"11369\" data-license=\"NA\" data-source=\"https://www.nature.com/articles/modpathol201038\" data-tags=\"April2025\" src=\"https://image.prepladder.com/notes/V4RHyneuNPxRrldB3e4w1745907699.png\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Mitotic rate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>High</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Variable</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Low to moderate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Variable</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Electron <span class=\"customMeta\" data-dictid=\"51df8cdfc91692777192aa76f4de51\">microscopy</span> findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dense core <span class=\"customMeta\" data-dictid=\"f9f635c47c16927771934f75253045\">neurosecretory</span> granules.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Desmosomes, tonofilaments, keratinisation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dense core <span class=\"customMeta\" data-dictid=\"f9f635c47c16927771934f75253045\">neurosecretory</span> granules.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Variable organelles, sometimes containing <span class=\"customMeta\" data-dictid=\"7d30ef9aee16927771936bdac2c1ff\">mucin</span> vacuoles</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>IHC markers</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive for <span class=\"customMeta\" data-dictid=\"7eca2476201692777193e0a0959bd7\">neuroendocrine</span> markers (e.g., <strong>chromogranin, synaptophysin</strong>).</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>P63,<strong> </strong><strong>p40</strong>, CK5/6</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Positive for <span class=\"customMeta\" data-dictid=\"7eca2476201692777193e0a0959bd7\">neuroendocrine</span> markers (e.g., <strong>chromogranin, synaptophysin</strong>)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Variable (e.g., <strong>TTF-1, Napsin A</strong> for primary lung adenocarcinoma)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with hyperkalemia and elevated urea levels underwent dialysis. Towards the end of the session, she became drowsy and had a sudden seizure episode. On examination, the patient was hypotensive. What is the treatment for this condition?", "options": [{"label": "A", "text": "Bumetanide", "correct": false}, {"label": "B", "text": "Ethacrynic acid", "correct": false}, {"label": "C", "text": "Nesiritide", "correct": false}, {"label": "D", "text": "IV Mannitol", "correct": true}], "correct_answer": "D. IV Mannitol", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer D - IV Mannitol:</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Complications associated with Hemodialysis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>During treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Between treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Hypotension:</strong> <strong>The most common <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"8a6b09beac1692777184b08a2b5766\">complication</span> during hemodialysis</strong>, especially in patients with diabetes mellitus.</li>\n<li><strong>Muscle cramps</strong>.</li>\n<li><strong>Anaphylactoid reactions: </strong>These reactions, particularly to the dialyser, are most common during its first use and are often associated with <strong>bio <span class=\"customMeta\" data-dictid=\"10dcdd93561692777190d73418c5a7\">incompatible</span> cellulosic-containing membranes.</strong></li>\n<li><strong>Cardiac arrhythmias: </strong>D/t <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> &amp; acid-base shifts.</li>\n<li><strong>Hemorrhage: </strong>D/t <span class=\"customMeta\" data-dictid=\"9beeeb58f6169277718129acb7bd01\">anticoagulation</span> &amp; <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> needle disconnection.</li>\n<li><strong>Air embolism: </strong>D/t faulty lines &amp; equipment malfunction.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Pulmonary oedema</strong> (D/t fluid overload).</li>\n<li><strong>Systemic sepsis: </strong>Usually involves <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> access devices (catheter or fistula).</li>\n<li><strong>Dialysis <span class=\"customMeta\" data-dictid=\"6020176bfd16927771866a4128521e\">disequilibrium</span> syndrome </strong>typically occurs during or after a patient's first <span class=\"customMeta\" data-dictid=\"5755720cc31692777186c957a0feb7\">dialysis</span> session. It presents with confusion, restlessness, headache, and muscle twitching. It is caused by a <strong>urea <span class=\"customMeta\" data-dictid=\"04136f692516927771888cf07d46a4\">gradient</span> between the <span class=\"customMeta\" data-dictid=\"123c47549916927771854892334fb9\">CSF</span> and blood that raises <span class=\"customMeta\" data-dictid=\"cd42e0ddad1692777190d18c595ec5\">intracranial</span> pressure.</strong></li>\n<li><strong>Amyloidosis (</strong>D/t<strong> <span class=\"customMeta\" data-dictid=\"806eb8418c16927771822855b56695\">beta</span> 2 microglobulin</strong>)</li>\n<li><strong>Carpal tunnel syndrome (</strong>due to <span class=\"customMeta\" data-dictid=\"51ad856e041692777181f80c9d507a\">amyloid</span> deposition in the <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">flexor</span> retinaculum).</li>\n<li><strong>Peripheral neuropathy</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a village, it is observed that several farmers have crossed gait and use a stick for support to stand up and walk. Due to poor yield from farms, they consume meals containing rice and pulses only. Supplementing their diet with which of the following vitamins could have prevented this?", "options": [{"label": "A", "text": "Vitamin A", "correct": false}, {"label": "B", "text": "Vitamin D", "correct": false}, {"label": "C", "text": "Vitamin C", "correct": true}, {"label": "D", "text": "Vitamin B", "correct": false}], "correct_answer": "C. Vitamin C", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/JBPidkVRfW6SnCQrC3KW1745315493.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Causative agent</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Beta-oxalyl <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> <span class=\"customMeta\" data-dictid=\"7f4e6edbc91692777181c6fa295ae7\">alanine</span> (BOAA) present in Lathyrus sativus</li>\n<li>Significant exposure : &gt;30% <span class=\"customMeta\" data-dictid=\"c3b8b9a17416927771906b1bebb13c\">inclusion</span> in diet over 2-6 months</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clinical features</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Latent stage: <span class=\"customMeta\" data-dictid=\"e684325d851692777196af9e64013b\">preventive</span> can be best implemented here</li>\n<li>No stick stage: most common point of diagnosis</li>\n<li>One-stick stage: <span class=\"customMeta\" data-dictid=\"9e2d8a3f5a16927771932c2348ec52\">muscular</span> <span class=\"customMeta\" data-dictid=\"b52ddf2a451692777199b4d38e5c53\">stiffness</span> begins</li>\n<li>Two-stick stage: will need crutches</li>\n<li>Crawler stage: <span class=\"customMeta\" data-dictid=\"9e2d8a3f5a16927771932c2348ec52\">muscular</span> <span class=\"customMeta\" data-dictid=\"97ff5253fb169277718224c7b0faf8\">atrophy</span> sets in.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Treatment</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Vitamin C prophylaxis: 500-1000 mg per day</li>\n<li>Banning the crop</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Toxin removal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Steeping method: soaking in hot water for 2 hours, drained and sun-dried.</li>\n<li>Parboiling: overnight soaking in limewater.</li>\n<li>Genetic approach: selecting variants with less BOAA content and cultivating the same.</li>\n<li>Educating people.</li>\n<li>Bringing socio-economic changes.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young patient presents with a large retroperitoneal haemorrhage and a history of intermittent knee swelling during strenuous exercise. There is no history of mucosal bleeding. Which of the following deficiencies is responsible for the condition mentioned above?", "options": [{"label": "A", "text": "Factors VIII and IX", "correct": true}, {"label": "B", "text": "GP1b/IX", "correct": false}, {"label": "C", "text": "Von Willebrand factor", "correct": false}, {"label": "D", "text": "Lupus anticoagulant", "correct": false}], "correct_answer": "A. Factors VIII and IX", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Hemophilia A</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Hemophilia B</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Deficient factor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Factor 8 deficiency</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Factor 9 deficiency</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathway affected</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Intrinsic <span class=\"customMeta\" data-dictid=\"3aa5abc2fa169277719488e088076d\">pathway</span> defect</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>APTT</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Elevated</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>BT, PT, and TT</strong></p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Normal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Cryoprecipitate, <span class=\"customMeta\" data-dictid=\"b566321fe8169277719716b1cf4df0\">Recombinant</span> factor 8 (Humate)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\">Fresh frozen plasma</p>\n<p style=\"text-align: center;\">(FFP)</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hemophilia A</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Factor 8 <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> (X-linked recessive)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hemophilia B</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Factor 9 <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> (X-linked recessive)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hemophilia C</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Factor 11 <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> (Autosomal recessive)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Parahemophilia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Factor 5 <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> (Autosomal recessive)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pseudo hemophilia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Also known as Von Willebrand disease</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female patient presents with severe restlessness, palpitations, and tremors to the emergency department. She is a known case of bronchial asthma. On examination, the neck looks swollen. Blood pressure is elevated, and tachycardia is noted. ECG shows atrial fibrillation. Which of the following drugs is used for immediate management in this patient?", "options": [{"label": "A", "text": "Diltiazem", "correct": true}, {"label": "B", "text": "Propranolol", "correct": false}, {"label": "C", "text": "Esmolol", "correct": false}, {"label": "D", "text": "Propylthiouracil", "correct": false}], "correct_answer": "A. Diltiazem", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - Diltiazem</p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Thyrotoxic crisis or <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> storm </strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>It is a life-threatening <span class=\"customMeta\" data-dictid=\"b5a5dcf4021692777187e3c0d2d47d\">exacerbation</span> of hyperthyroidism</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Fever</li>\n<li>Delirium, seizures, coma</li>\n<li>Vomiting, diarrhea</li>\n<li>Jaundice</li>\n<li>Hyperthermia</li>\n<li>Cardiac failure</li>\n<li>Arrhythmias</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Precipitating factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Precipitating factors:</strong></p>\n<p><strong>Stress: </strong></p>\n<ul>\n<li>Acute illnesses like stroke, trauma, <span class=\"customMeta\" data-dictid=\"a5603ff98316927771865d7ae41f16\">diabetic</span> ketoacidosis</li>\n<li>Surgery, commonly of the thyroid</li>\n</ul>\n<p><strong>Infections </strong></p>\n<p><strong>Acute <span class=\"customMeta\" data-dictid=\"58c4fcb71116927771901e83ac026f\">iodine</span> load: </strong></p>\n<ul>\n<li>Radioiodine treatment of a patient with partially or untreated hyperthyroidism</li>\n<li>Iodinated contrast agents</li>\n<li>Amiodarone administeration</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Management of the precipitating factors (digoxin, diuretics, &amp; oxygen)</li>\n</ul>\n<ul>\n<li>IV fluids and ice pack</li>\n<li>Propylthiouracil (DOC)</li>\n<li>Methimazole/carbimazole</li>\n<li>Beta-blockers</li>\n<li>Corticosteroids</li>\n<li>Lugol’s iodine/ sodium ipodate </li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An elderly male presents for a routine medical examination. Laboratory investigations reveal a very high total leukocyte count (TLC). The peripheral smear shows findings as shown in the image. What is the appropriate next step for this patient?", "options": [{"label": "A", "text": "Stem cell transplantation", "correct": false}, {"label": "B", "text": "Bone marrow biopsy", "correct": false}, {"label": "C", "text": "Flow cytometry", "correct": true}, {"label": "D", "text": "Start high-dose chemotherapy", "correct": false}], "correct_answer": "C. Flow cytometry", "question_images": ["https://image.prepladder.com/content/72AJRgP35nwPyqs3iHUG1745315722.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Chronic Lymphocytic Leukemia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Genetics: </strong>Trisomy 12,<strong> <span class=\"customMeta\" data-dictid=\"cf1e8ec6121692777185eba2630061\">deletion</span> 13q14</strong>, and others</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Origin:</strong> Post–germinal <span class=\"customMeta\" data-dictid=\"1feb2a0a3016927771847db9449f75\">centre</span> memory<strong> </strong><strong>B cell</strong><strong> </strong>or naive B Cells in the <span class=\"customMeta\" data-dictid=\"5ec65d4890169277719136decb922c\">mantle</span> zone of the <span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\">lymph</span> node.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Etiopathogenesis</strong></p>\n<ul>\n<li>Antiapoptotic protein BCL2 overexpression.</li>\n<li>CLL cell growth depends on Bruton Tyrosine <span class=\"customMeta\" data-dictid=\"9863da498e1692777190e1c6515b48\">kinase</span> (BTK) activity.</li>\n<li>No association with radiation exposure</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n<ul>\n<li>Most common Leukemia in the elderly.</li>\n<li>Frequently <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> at diagnosis.</li>\n<li>May present with fatigue, lymphadenopathy, hepatosplenomegaly, or infection due to immunosuppression.</li>\n<li>Associated with <span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\">autoimmune</span> <span class=\"customMeta\" data-dictid=\"d30ae941d516927771889351160b00\">hemolytic</span> anemia- spherocytes can be seen on <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> smear</li>\n<li>Can l/t Hypogammaglobulinemia( highlight )as B cells are <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> -</li>\n<li>Infection is the M/C/C of death in CLL</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Laboratory diagnosis:</strong></p>\n<ul>\n<li>Absolute <span class=\"customMeta\" data-dictid=\"c605d4126116927771916c2002638e\">lymphocyte</span> count (ALC) &gt; 5000/mm3</li>\n<li>Bone <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">marrow</span> lymphocytes &gt;30%</li>\n<li>Surface markers using flow <span class=\"customMeta\" data-dictid=\"551a62b1ec169277718587f847e627\">cytometry</span> were positive for <strong>CD5, CD23, CD19, and CD20.</strong>\n<ul>\n<li>CLL co-expresses both T cell (CD5) and B cell (CD20, CD19) markers</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old male is found to be positive for HBsAg and HBeAg and is diagnosed with chronic hepatitis B. The viral load of the patient was 2 x 100,000, and SGPT is found to be doubled. What is the appropriate management in this patient?", "options": [{"label": "A", "text": "Lamivudine for 30+ weeks", "correct": false}, {"label": "B", "text": "Tenofovir for &amp;gt;40 weeks", "correct": true}, {"label": "C", "text": "Pegylated interferon for 52 weeks", "correct": false}, {"label": "D", "text": "Combined pegylated interferon with lamivudine", "correct": false}], "correct_answer": "B. Tenofovir for &gt;40 weeks", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - &lt;span class=\"customMeta\" data-dictid=\"8ed4f962f416927772008ece0f551e\"&gt;Tenofovir&lt;/span&gt; for &amp;gt;40 week\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Research is being conducted to find the association between aniline dye exposure and bladder cancer in workers who have worked in the industry for &amp;gt;20 years. Two groups were formed: one directly involved with dye handling and the other group consisting of office clerks not directly exposed to the dye. Years of occupation were noted from records. What type of study is being performed?", "options": [{"label": "A", "text": "Retrospective cohort study", "correct": true}, {"label": "B", "text": "Prospective cohort study", "correct": false}, {"label": "C", "text": "Case-control study", "correct": false}, {"label": "D", "text": "Intervention and response", "correct": false}], "correct_answer": "A. Retrospective cohort study", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/9fKd5I5P9trfhK3S4mTi1745909331.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old male presented with low haemoglobin, a platelet count of 25,000/mL, gum bleeding, and raised PT and aPTT. The image of his peripheral smear is shown below. What is the likely diagnosis?", "options": [{"label": "A", "text": "AML with t(8;21)", "correct": false}, {"label": "B", "text": "AML with inv(16)", "correct": false}, {"label": "C", "text": "AML with t(15;17)", "correct": true}, {"label": "D", "text": "AML with t(11;22)", "correct": false}], "correct_answer": "C. AML with t(15;17)", "question_images": ["https://image.prepladder.com/content/y0YOrS15SN96UlWNHCYX1745315967.png"], "explanation_images": ["https://image.prepladder.com/content/tS4CqlJvY8efJemdBPIc1745316127.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>FAB <span class=\"customMeta\" data-dictid=\"dda6ab11271692777184264b752d39\">classification</span> of AML</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Subtype</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Name</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Features</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>AML-M0</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>AML undifferentiated</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>MPO negative</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>AML-M1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>AML without maturation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>MPO +</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>AML-M2</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>AML with maturation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Most common</li>\n<li>t(8:21) RUNX1-RUNX1T1 fusion</li>\n<li>Associated with chloroma.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>AML-M3</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acute promyelocytic leukemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>t(15:17) - PML-RAR𝛼 fusion</strong></li>\n<li>Blocks <span class=\"customMeta\" data-dictid=\"cb12d6781c16927771962b853d3946\">promyelocyte</span> → <span class=\"customMeta\" data-dictid=\"23b7c84dee1692777193cbdc4c453d\">myelocyte</span> transformation.</li>\n<li>Bone marrow: <strong>Auer rods</strong> <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> criss-cross called faggot cell.</li>\n</ul>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Mikael Häggström, M.D\" data-hash=\"\" data-license=\"CC0\" data-source=\"https://commons.wikimedia.org/wiki/File:Cytology_of_acute_promyelocytic_leukemia,_annotated.png\" data-tags=\"\" height=\"266\" src=\"https://image.prepladder.com/content/tS4CqlJvY8efJemdBPIc1745316127.png\" width=\"390\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n<ul>\n<li>Can cause <span class=\"customMeta\" data-dictid=\"f4006059f916927771865569d4da7d\">disseminated</span> <span class=\"customMeta\" data-dictid=\"837d6227d81692777190a063ea2cd4\">intravascular</span> <span class=\"customMeta\" data-dictid=\"42f1e4deb8169277718412c0681a54\">coagulation</span> (DIC)</li>\n<li>PAS+</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>AML-M4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acute <span class=\"customMeta\" data-dictid=\"215dafdbad1692777193dcb48ddd63\">myelomonocytic</span> leukemia</strong><br/>\n<strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Associated with <strong>inv 16</strong> and <strong>CBF-MYH <span class=\"customMeta\" data-dictid=\"a7dfeb385e1692777203302bcf142d\">fusion</span> gene</strong></li>\n<li>Gums: <span class=\"customMeta\" data-dictid=\"09980563461692777188b0de904031\">Gum</span> hypertrophy</li>\n<li>Skin: Leukaemia cutis</li>\n<li>MPO+, NSE +</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>AML-M5</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acute <span class=\"customMeta\" data-dictid=\"7eae8f57ab16927771922b5f3d81e4\">monocytic</span> leukemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Gums: <span class=\"customMeta\" data-dictid=\"09980563461692777188b0de904031\">Gum</span> hypertrophy</li>\n<li>Skin: Leukaemia cutis</li>\n<li>MPO-, NSE +</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>AML-M6</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acute <span class=\"customMeta\" data-dictid=\"892718f3e916927771871389d2e1a3\">erythroid</span> leukemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Also called <strong>Di Guglielmo Disease</strong></li>\n<li>Diffuse PAS+, cd71</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>AML-M7</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Acute megakaryocytic leukemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Bone <span class=\"customMeta\" data-dictid=\"c8a8c935a41692777191610f6aacb4\">Marrow</span> <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> gives a dry tap</li>\n<li>PAS+, cd41 and cd61</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old male patient came with complaints of palpitations, sweating, and restlessness. He has a complaint of sweaty palms. Clinical findings are depicted in the image given below. What is the diagnostic finding seen in this patient?", "options": [{"label": "A", "text": "Anti-thyroglobulin antibody", "correct": false}, {"label": "B", "text": "Anti-thyroid peroxidase antibody", "correct": false}, {"label": "C", "text": "Thyroid receptor antibody", "correct": true}, {"label": "D", "text": "Elevated ultrasensitive thyrotropin levels", "correct": false}], "correct_answer": "C. Thyroid receptor antibody", "question_images": ["https://image.prepladder.com/notes/VWZIKPcCWxlxoiVZs29y1745917374.png"], "explanation_images": ["https://image.prepladder.com/content/3lRl6NdHZmwSRXOhIwV71745316066.png", "https://image.prepladder.com/content/NUnBsF2VETReRkboIo6d1745316066.png", "https://image.prepladder.com/notes/ZhS6LSoHHC9TynEJbRoT1745917375.png", "https://image.prepladder.com/notes/JxvJPMYt1WlgW1oe6MSt1745917377.png"], "explanation": "<p>Correct Answer C - &lt;span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\"&gt;Thyroid&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\"&gt;receptor&lt;/span&gt; antibody</p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Signs in Grave’s <span class=\"customMeta\" data-dictid=\"69c1aa5a791692777194e7ea64bc17\">ophthalmopathy</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"> </p>\n<p style=\"text-align:center\"><strong>Dalrymple’s sign </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Jonathan Trobe\" data-hash=\"\" data-license=\"CC BY 3.0\" data-source=\"https://en.wikipedia.org/wiki/Graves%27_ophthalmopathy#/media/File:Proptosis_and_lid_retraction_from_Graves'_Disease.jpg\" data-tags=\"\" height=\"230\" src=\"https://image.prepladder.com/content/3lRl6NdHZmwSRXOhIwV71745316066.png\" width=\"349\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>It is due to the <span class=\"customMeta\" data-dictid=\"ca2289e348169277718516017eb2ba\">contraction</span> of Muller’s muscles</li>\n<li>Upper lid retraction</li>\n<li>M/C presenting sign</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Von Graefe’s sign/ Lid-lag/ Stare sign </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Esra Şahlı,Kaan Gündüz\" data-hash=\"\" data-license=\"CC BY 2.5\" data-source=\"Right upper lid retraction in a 38-year-old male patient. Upper lid... | Download Scientific Diagram (researchgate.net)\" data-tags=\"\" height=\"148\" src=\"https://image.prepladder.com/content/NUnBsF2VETReRkboIo6d1745316066.png\" width=\"350\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>It is the inability to close the upper eyelid</li>\n<li>It is the earliest sign</li>\n<li>There is inadequate blinking leading to exposure keratitis</li>\n<li>Lid <span class=\"customMeta\" data-dictid=\"6ef2a80e2116927771915098fa1789\">lag</span> of the upper <span class=\"customMeta\" data-dictid=\"819ddea9e51692777187cdff06b437\">eyelid</span> on downward gaze</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Enroth’s sign </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"PIM057\" data-author=\"Cătălin Buzdugă, Dana Turliuc, Corina Galesanu, Delia Ciobanu, Gabriela Dimitriu, Andrei Cucu, Gabriela Florenta Dumitrescu, Anca Sava, Claudia Florida Costea\" data-hash=\"11418\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/Opthamopathy-in-Graves-disease-eyelid-edema-Enroth-sign-and-conjunctival-chemosis-Dr_fig1_304581387\" data-tags=\"April2025\" height=\"172\" src=\"https://image.prepladder.com/notes/ZhS6LSoHHC9TynEJbRoT1745917375.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>It is the fullness/ <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> of the lower eyelids</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Gifford’s sign </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">_</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Difficulty in <span class=\"customMeta\" data-dictid=\"30ddb5b09916927771877ac72c09b7\">eversion</span> of the upper eyelid</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Mobius sign </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">_</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Convergence weakness</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Griffith sign </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"PIM058\" data-author=\"Mr. Peter Fells\" data-hash=\"11419\" data-license=\"NA\" data-source=\"https://entokey.com/endocrine-disease-and-the-eye/\" data-tags=\"April2025\" height=\"137\" src=\"https://image.prepladder.com/notes/JxvJPMYt1WlgW1oe6MSt1745917377.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Lower lid <span class=\"customMeta\" data-dictid=\"6ef2a80e2116927771915098fa1789\">lag</span> on upward gaze</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Stellwag’s sign </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">_</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Incomplete and infrequent blinking</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Joffroy’s sign </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">_</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Lack of wrinkling of the forehead in superior gaze</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Gellineck sign </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">_</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Abnormal <span class=\"customMeta\" data-dictid=\"b5f46d7e431692777195efd6b43e9f\">pigmentation</span> of the upper eyelid</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Who is responsible for counseling and providing information to the patient, a 30-week primigravida experiencing reduced vision at night, who has been avoiding certain fruits during her pregnancy due to concerns about their potential abortifacient effects?", "options": [{"label": "A", "text": "ANM", "correct": false}, {"label": "B", "text": "AWW", "correct": false}, {"label": "C", "text": "Trained birth attendant", "correct": false}, {"label": "D", "text": "ASHA", "correct": true}], "correct_answer": "D. ASHA", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:616px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>ASHA (Accredited Social Health Activist)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p>ASHA is a woman (married, divorced, or widowed) resident of the village, aged 25-45 years, with education up to 8th grade.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Population Norm for ASHA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>The general norm is 1 <span class=\"customMeta\" data-dictid=\"817804153a16927771822a30e05c60\">ASHA</span> per 1000 population. In tribal, hilly, and desert areas, this may be relaxed to 1 <span class=\"customMeta\" data-dictid=\"817804153a16927771822a30e05c60\">ASHA</span> per habitation.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Role and Responsibilities of ASHA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>Health Activist: </strong>Create awareness and provide information on health determinants, existing services, and the importance of health and family welfare.</li>\n<li><strong>Counselor</strong>: Provide counseling on birth preparedness, safe delivery, and family planning.</li>\n<li><strong>Mobilizer:</strong> Help the community access health services, such as immunizations, sanitation, and nutrition.</li>\n<li><strong>Provider: </strong>Offer basic care for common illnesses and first-aid, and act as a <span class=\"customMeta\" data-dictid=\"25116121ed169277718644b8fe30ff\">depot</span> for essential medications.</li>\n<li><strong>Community Engagement:</strong> Work with village health committees and panchayats for planning and awareness.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Specific Responsibilities of ASHA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Promote health and <span class=\"customMeta\" data-dictid=\"18aafee1a71692777198cdc688e8aa\">sanitation</span> practices.</li>\n<li>Advise on child care, immunization, and <span class=\"customMeta\" data-dictid=\"11e24b369816927771974383c7e17c\">reproductive</span> health.</li>\n<li>Assist with family planning and treatment of minor ailments.</li>\n<li>Mobilize pregnant women and children to health services</li>\n<li>Provide basic medical care and support for diarrhea, fever, and <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> (under DOTS).</li>\n<li>Serve as a <span class=\"customMeta\" data-dictid=\"25116121ed169277718644b8fe30ff\">depot</span> holder for essential drugs and medical supplies.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Role and Integration with Anganwadi</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>The Anganwadi worker helps guide ASHA, particularly in organizing Health Day activities, mobilizing village women and children, and promoting <span class=\"customMeta\" data-dictid=\"05bef24e711692777193a154b462b4\">nutrition</span> and health education.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Role and Integration with ANMs (Auxiliary Nurse Midwives)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>ANMs guide <span class=\"customMeta\" data-dictid=\"817804153a16927771822a30e05c60\">ASHA</span> in areas like immunization, safe pregnancy, and health education, and assist in organizing Health Days. ANMs also help with training and monitor ASHA's performance.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old HIV patient presented with a painful lesion, as shown in the image. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Basal cell carcinoma", "correct": false}, {"label": "B", "text": "Kaposi sarcoma", "correct": true}, {"label": "C", "text": "Malignant melanoma", "correct": false}, {"label": "D", "text": "Squamous cell carcinoma", "correct": false}], "correct_answer": "B. Kaposi sarcoma", "question_images": ["https://image.prepladder.com/notes/PjPjZS9P3uSBqYVLaaNp1745917378.png"], "explanation_images": [], "explanation": "<p>Correct Answer B - K\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A chronic smoker who worked in a cement factory for 20 years developed mesothelioma. It is due to?", "options": [{"label": "A", "text": "Silicosis", "correct": false}, {"label": "B", "text": "Asbestosis", "correct": true}, {"label": "C", "text": "Coal worker pneumoconiosis", "correct": false}, {"label": "D", "text": "Bagassosis", "correct": false}], "correct_answer": "B. Asbestosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/LJ4bsyyF1JnybjCNQSBl1745316470.png", "https://image.prepladder.com/content/CqNtpRzWOE8pwhUlovf31745316481.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Mesothelioma</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\">A rare cancer arising from mesothelial cells that most commonly affects the pleura, and it can also affect the peritoneum, pericardium, and <span class=\"customMeta\" data-dictid=\"35814a93301692777201bab0f52c19\">tunica</span> vaginalis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mesothelioma is the most specific asbestos-associated cancer</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Advanced pleural <span class=\"customMeta\" data-dictid=\"9f56633f181692777192f07ed38b1a\">mesothelioma</span> can cause extensive pleural <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> and thickening,</li>\n<li>making the affected side rigid and immobile</li>\n<li>Later stages fix the <span class=\"customMeta\" data-dictid=\"be2aea1ed01692777192b46ee482a3\">mediastinum</span> in place due to pleural thickening and fibrosis.</li>\n<li>A <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> shift is not a characteristic feature of mesothelioma.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Progressive dyspnea, chest pain, weight loss, chronic cough, hemoptysis</li>\n<li>Decreased <span class=\"customMeta\" data-dictid=\"baa424d2de16927771836afd73785b\">breath sounds</span> and <span class=\"customMeta\" data-dictid=\"e452a3bf5716927771867e7ea9b4da\">dullness</span> to <span class=\"customMeta\" data-dictid=\"4818bebdf31692777195cc835c12d4\">percussion</span> (due to pleural <span class=\"customMeta\" data-dictid=\"73909075e71692777187f08d3c9b7e\">effusion</span> or thickening).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>CT scan</strong> shows <strong>Pleural thickening, effusion, or frozen hemithorax</strong> (not causing a <span class=\"customMeta\" data-dictid=\"1014e4cf5e169277719246e0ca91df\">mediastinal</span> shift in the presence of effusion)</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Gaillard F, Mesothelioma - sarcomatoid. Case study, Radiopaedia.org (Accessed on 06 Dec 2024) https://doi.org/10.53347/rID-8705\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/mesothelioma-sarcomatoid#image-317742\" data-tags=\"\" height=\"248\" src=\"https://image.prepladder.com/content/LJ4bsyyF1JnybjCNQSBl1745316470.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Leong P, Mesothelioma. Case study, Radiopaedia.org (Accessed on 06 Dec 2024) https://doi.org/10.53347/rID-26805\" data-hash=\"\" data-license=\"NA\" data-source=\"https://radiopaedia.org/cases/mesothelioma-23#image-5530797\" data-tags=\"\" height=\"249\" src=\"https://image.prepladder.com/content/CqNtpRzWOE8pwhUlovf31745316481.png\" width=\"350\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>Biopsy (Diagnosis can be confirmed)</strong></p>\n<ul>\n<li><strong>Epithelioid mesothelioma</strong> shows tubules, nests, or <span class=\"customMeta\" data-dictid=\"62b9af909d1692777194cd004f10f4\">papillary</span> structures with uniform round to <span class=\"customMeta\" data-dictid=\"74793d564816927771943ae4ba74b3\">oval</span> <span class=\"customMeta\" data-dictid=\"e6b47028191692777193eb698e43b6\">nuclei</span> and <span class=\"customMeta\" data-dictid=\"91bc3a9b3e16927771871bcff74db7\">eosinophilic</span> cytoplasm.</li>\n<li><strong>Sarcomatoid mesothelioma</strong> consists of spindle-shaped cells resembling fibrosarcoma.</li>\n<li><strong>Biphasic mesothelioma</strong> displays a mixture of both patterns.</li>\n</ul>\n<p><strong>Specific</strong> <strong>markers</strong> for mesothelioma</p>\n<ul>\n<li><strong>Calretinin </strong></li>\n<li>Epithelial <span class=\"customMeta\" data-dictid=\"34cd707428169277719272942b7905\">membrane</span> antigen</li>\n<li>Cytokeratin</li>\n<li>Mesothelin</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Prognosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Poor - <span class=\"customMeta\" data-dictid=\"979385c98a1692777192fb1721a16e\">median</span> survival of 9-21 months</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 22-year-old female comes to the STI clinic with minimal vaginal discharge. On speculum examination, erosions are seen on the cervix. Which of the following kit should be given to this patient?", "options": [{"label": "A", "text": "Green", "correct": false}, {"label": "B", "text": "Red", "correct": false}, {"label": "C", "text": "Grey", "correct": true}, {"label": "D", "text": "Yellow", "correct": false}], "correct_answer": "C. Grey", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Kit</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Colour</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Indication</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Medicines</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Grey</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>→ Urethral discharge</p>\n<p>→ Cervicitis</p>\n<p>→ Ano-rectal discharge</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Azithromycin, cefixime</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Green <strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Vaginitis</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Secnidazole, fluconazole</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>White</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Non-herpetic <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">genital</span> ulcers</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Azithromycin, B. Penicillin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>4</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Blue</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>→ <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">Genital</span> ulcers</p>\n<p>→ <span class=\"customMeta\" data-dictid=\"7f576b591a1692777195da1639d0fe\">Penicillin</span> <span class=\"customMeta\" data-dictid=\"aa1288c36b16927771814fa5aa84eb\">allergy</span> +</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Azithromycin, doxycycline</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>5</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Red <strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Herpetic <span class=\"customMeta\" data-dictid=\"0e919a208b16927771885d9c1f6662\">genital</span> ulcers</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Acyclovir</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Yellow <strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Lower <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cefixime metronidazole, doxycycline</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>7</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Black</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inguinal bubo</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Azithromycin, doxycycline</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>8</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Brown</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anorectal <span class=\"customMeta\" data-dictid=\"9dd87431ba1692777186ecfb21d258\">discharge</span> syndrome</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cefixime, doxycycline</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient is brought to the OPD by his wife complaining about difficulty in expressing emotions and not taking part in daily activities. On examination, resting tremors and rigidity are noted. Given the possible diagnosis, which part of the brain is affected in this patient?", "options": [{"label": "A", "text": "Basal ganglia", "correct": true}, {"label": "B", "text": "Hippocampus", "correct": false}, {"label": "C", "text": "Cerebellum", "correct": false}, {"label": "D", "text": "Premotor cortex", "correct": false}], "correct_answer": "A. Basal ganglia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - &lt;span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\"&gt;Basal&lt;/span&gt; gang\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Area of Lesion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Consequences </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Frontal Lobe</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Disinhibition and deficits in concentration, orientation, judgment</li>\n<li>May have reemergence of <span class=\"customMeta\" data-dictid=\"6d6e7d903b169277719662541dd5e2\">primitive</span> reflexes.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Frontal Eye Fields</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Eyes look toward the lesion.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Paramedian <span class=\"customMeta\" data-dictid=\"a533b2d59f1692777196694dbb1b2a\">Pontine</span> <span class=\"customMeta\" data-dictid=\"0b6b1f44cb1692777197afef785626\">Reticular</span> Formation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Eyes look away from the side of the lesion.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Medial <span class=\"customMeta\" data-dictid=\"7ba18aa5e616927771918a45051a40\">Longitudinal</span> Fasciculus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Internuclear <span class=\"customMeta\" data-dictid=\"2cc1b4ff2216927771940a80e764a2\">ophthalmoplegia</span> (impaired <span class=\"customMeta\" data-dictid=\"9efe7f9e921692777180ed75f4948a\">adduction</span> of <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> eye; <span class=\"customMeta\" data-dictid=\"1ca218aa7e1692777193e1da961e31\">nystagmus</span> of <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> eye with abduction).</li>\n<li>Eg: Multiple sclerosis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Dominant <span class=\"customMeta\" data-dictid=\"51df38de3d1692777194ced4c4bab5\">Parietal</span> Cortex</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Gerstmann syndrome: </strong>Agraphia, acalculia, finger agnosia, left-right disorientation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Nondominant <span class=\"customMeta\" data-dictid=\"51df38de3d1692777194ced4c4bab5\">Parietal</span> Cortex</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Hemispatial <span class=\"customMeta\" data-dictid=\"bc4fd945b61692777193cadcf42cfb\">neglect</span> syndrome: </strong>Agnosia of the <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> side of the world.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Hippocampus (Bilateral)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Anterograde amnesia: Inability to make new memories.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Basal Ganglia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>May result in tremors at rest, chorea, and athetosis.</li>\n<li>Eg: Parkinson disease, Huntington disease.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Subthalamic Nucleus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Contralateral hemiballismus.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Mammillary Bodies (Bilateral)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Wernicke-Korsakoff syndrome: </strong>Confusion, ataxia, nystagmus, ophthalmoplegia, memory loss (anterograde and <span class=\"customMeta\" data-dictid=\"e38ca8e6931692777197ee6a68ac56\">retrograde</span> amnesia), confabulation, personality changes.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Amygdala (Bilateral)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Klüver-Bucy syndrome: </strong>Disinhibited behavior (eg, hyperphagia, hypersexuality, hyperorality).</li>\n<li>Eg: HSV-1 encephalitis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Superior Colliculus</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Parinaud syndrome: </strong>Paralysis of <span class=\"customMeta\" data-dictid=\"2421c657771692777185af1b7b59c3\">conjugate</span> vertical gaze (rostral <span class=\"customMeta\" data-dictid=\"f46ba26d111692777190def3b1d80a\">interstitial</span> <span class=\"customMeta\" data-dictid=\"ff628904401692777193c8a9f9159e\">nucleus</span> also involved).</li>\n<li>Eg: Stroke, hydrocephalus, pinealoma.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Reticular Activating System (Midbrain)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Reduced levels of <span class=\"customMeta\" data-dictid=\"bf639c9a2316927771825e1632d9fb\">arousal</span> and <span class=\"customMeta\" data-dictid=\"882ef330fb16927772022093f7518f\">wakefulness</span> (eg, coma).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cerebellar Hemisphere</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Intention tremor, limb ataxia, loss of balance; damage to <span class=\"customMeta\" data-dictid=\"a9c41a58d816927771847775d63d96\">cerebellum</span> → <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">Ipsilateral</span> deficits; fall toward side of lesion.</li>\n<li>(Cerebellar hemispheres are laterally located and affect <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> limbs)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cerebellar Vermis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Truncal ataxia</li>\n<li>Dysarthria</li>\n<li>(Vermis is centrally located and affects central body)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a 10-year-old school child, which of the following vaccines is given as a part of the school immunization program?", "options": [{"label": "A", "text": "Measles vaccine", "correct": false}, {"label": "B", "text": "Rotavirus vaccine", "correct": false}, {"label": "C", "text": "Td vaccine", "correct": true}, {"label": "D", "text": "Hepatitis B vaccine", "correct": false}], "correct_answer": "C. Td vaccine", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:724px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\">Vaccine</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\">Due age</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\">Dose</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\">Route</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\">Site</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">BCG</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">At birth</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">&lt; 1 month - 0.05 ml</p>\n<p style=\"text-align: center;\">&gt; 1 month - 0.1 ml</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Intradermal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Left upper arm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Hepatitis B</p>\n<p style=\"text-align: center;\"><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">At birth</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">0.5 ml</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Intramuscular</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Anterolateral aspect of left <span class=\"customMeta\" data-dictid=\"75b57d54f21692777192dc01883ad1\">mid</span> thigh</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">OPV -0</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">At birth</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">2 drops</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Oral</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Oral</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">OPV 1,2,3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">6, 10,14 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">2 drops</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Oral</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Oral</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Pentavalent 1,2,3</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">6,10,14 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">0.5 ml</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Intramuscular</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Anterolateral aspect of left <span class=\"customMeta\" data-dictid=\"75b57d54f21692777192dc01883ad1\">mid</span> thigh</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">IPV</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">6,14 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">0.1 ml</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Intradermal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Right upper arm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Rotavirus</p>\n<p style=\"text-align: center;\"><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">6,10,14 weeks</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">5 drops</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Oral</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Oral</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Pneumococcal vaccine</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">6,14 weeks</p>\n<p style=\"text-align: center;\">At 9 completed months</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">0.5 ml</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Intramuscular</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Anterolateral aspect of right <span class=\"customMeta\" data-dictid=\"75b57d54f21692777192dc01883ad1\">mid</span> thigh</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">1st dose Measles/ Rubella</p>\n<p style=\"text-align: center;\"><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">At 9 completed months - 12 months</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">0.5 ml</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Subcutaneous</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Right upper arm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">1st dose JE</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">At 9 completed months - 12 months</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">0.5 ml</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Subcutaneous</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Left upper arm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">1st dose Vitamin A</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">At 9 completed months</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">1 ml</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Oral</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Oral</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">DPT- <span class=\"customMeta\" data-dictid=\"7725db2655169277718388f647e647\">booster</span> 1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">16-24 months</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">0.5 ml</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Intramuscular</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Anterolateral aspect of left <span class=\"customMeta\" data-dictid=\"75b57d54f21692777192dc01883ad1\">mid</span> thigh</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">2nd dose Measles/ Rubella</p>\n<p style=\"text-align: center;\"><strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">16-24 months</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">0.5 ml</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Subcutaneous</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Right upper arm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">OPV booster</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">16-24 months</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">2 drops</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Oral</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Oral</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">2nd dose JE</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">16-24 months</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">0.5 ml</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Subcutaneous</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Left upper arm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">2nd-9th dose Vit A</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">At 16, then one dose every 6 months</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">2 ml</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Oral</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Oral</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">DPT- <span class=\"customMeta\" data-dictid=\"7725db2655169277718388f647e647\">booster</span> 2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">5-6 years</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">0.5 ml</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Intramuscular</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Upper arm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">TT</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">10 years and 16 years</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">0.5 ml</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Intramuscular</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Upper arm</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"5\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">For Pregnant women</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">TT-1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Early pregnancy</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">0.5 ml</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Intramuscular</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Upper arm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">TT-2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">4 weeks following TT1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">0.5 ml</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Intramuscular</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Upper arm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">TT booster</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">If mother has taken TT disease in pregnancy within the last 3 years</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">0.5 ml</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Intramuscular</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\">Upper arm</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old HIV-positive male came with complaints of persistent cough and weight loss. He has skin lesions that appear as umbilicated papules and nodules predominantly on the face, trunk, and upper extremities. Chest x-ray showed multiple bilateral nodular infiltrates. His sputum CBNAAT for tuberculosis was negative and he has a low CD4 count. What is the probable diagnosis?", "options": [{"label": "A", "text": "HIV with disseminated histoplasmosis", "correct": true}, {"label": "B", "text": "HIV with disseminated cryptococcosis", "correct": false}, {"label": "C", "text": "HIV with molluscum contagiosum", "correct": false}, {"label": "D", "text": "HIV with tuberculosis", "correct": false}], "correct_answer": "A. HIV with disseminated histoplasmosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer A - &lt;span class=\"customMeta\" data-dictid=\"fa9d83d3d41692777189a8b393dd60\"&gt;HIV&lt;/span&gt; with &lt;span class=\"customMeta\" data-dictid=\"f4006059f916927771865569d4da7d\"&gt;disseminated&lt;/span&gt; h\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a female patient, there is a complaint of vision loss, specifically affecting the right halves of both eyes. Where is the lesion located?", "options": [{"label": "A", "text": "Optic nerve", "correct": false}, {"label": "B", "text": "Left optic tract", "correct": true}, {"label": "C", "text": "Optic chiasma", "correct": false}, {"label": "D", "text": "Right optic tract", "correct": false}], "correct_answer": "B. Left optic tract", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/j3pGsqQG9ZUQpYW2XRf71745317015.png", "https://image.prepladder.com/content/6fXMVnwElzkObvLzQXtd1745317044.png", "https://image.prepladder.com/content/v3QXGL32BM9AtoazhLSq1745317051.png", "https://image.prepladder.com/content/V6e4Kqb8cGo34StHHu8o1745317058.png", "https://image.prepladder.com/content/44axlJZhpNFSuucStWVM1745317064.png", "https://image.prepladder.com/content/1IGz3Ee0Vc3gfZchGDxV1745317071.png", "https://image.prepladder.com/content/Pk1nARXkMXiyb8hHfoPN1745317079.png", "https://image.prepladder.com/content/YkQJVVX4Pf4BLthw81mR1745317084.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Visual Pathway Lesions and Defects</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Site of Lesion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Fibers Affected</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Field Defect</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Optic Nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ipsilateral <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">Temporal</span> + Nasal Fibers <strong>(Option A ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"278\" src=\"https://image.prepladder.com/content/6fXMVnwElzkObvLzQXtd1745317044.png\" width=\"297\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align:center\"><strong>Anopia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Optic Chiasma</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bilateral Nasal Fibers <strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"307\" src=\"https://image.prepladder.com/content/v3QXGL32BM9AtoazhLSq1745317051.png\" width=\"313\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align:center\"><strong>Bitemporal Hemianopia</strong></p>\n<p style=\"text-align:center\"><strong>(Heteronymous Hemianopia)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Optic Tract</strong></li>\n<li><strong>Lateral Geniculate Body (LGB Lesion)</strong></li>\n<li><strong>Optic Radiation</strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ipsilateral <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">Temporal</span> Fibers + <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">Contralateral</span> Nasal Fibers</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"313\" src=\"https://image.prepladder.com/content/V6e4Kqb8cGo34StHHu8o1745317058.png\" width=\"313\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align:center\"><strong>Homonymous Hemianopia</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Visual Cortex without the involvement of tip</strong></p>\n<p><strong>(Post. Cerebral Artery)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ipsilateral <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">Temporal</span> Fibers + <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">Contralateral</span> Nasal Fibers except <span class=\"customMeta\" data-dictid=\"ebad8eb48c1692777191b5de5d04a1\">macular</span> representation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"313\" src=\"https://image.prepladder.com/content/44axlJZhpNFSuucStWVM1745317064.png\" width=\"313\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align:center\"><strong>Homonymous <span class=\"customMeta\" data-dictid=\"64341b503a1692777188b9a3b26c59\">Hemianopia</span> with <span class=\"customMeta\" data-dictid=\"ebad8eb48c1692777191b5de5d04a1\">Macular</span> Sparing</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Tip of Visual Cortex</strong></p>\n<p><strong>(Middle Cerebral Artery)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Macular Representation of Ipsilateral <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">Temporal</span> and <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">Contralateral</span> Nasal Fibers.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"313\" src=\"https://image.prepladder.com/content/1IGz3Ee0Vc3gfZchGDxV1745317071.png\" width=\"313\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p style=\"text-align:center\"><strong>Macular <span class=\"customMeta\" data-dictid=\"0600a6b52316927771899e12e7ec86\">Homonymous</span> Hemianopia</strong></p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Aspect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Inferior <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">Optic</span> Radiations</strong></p>\n<p style=\"text-align:center\"><strong>(Meyer’s Loop)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Superior <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">Optic</span> Radiations</strong></p>\n<p style=\"text-align:center\"><strong>(Baum’s Loop)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Location of Lesion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Temporal <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Parietal lobe</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Affected Visual Field</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Superior quadrants of the <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> visual field</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inferior quadrants of the <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> visual field</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Visual Defect</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Superior <span class=\"customMeta\" data-dictid=\"0600a6b52316927771899e12e7ec86\">homonymous</span> <span class=\"customMeta\" data-dictid=\"e0b79d0fde16927771965173ff3031\">quadrantanopia</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inferior <span class=\"customMeta\" data-dictid=\"0600a6b52316927771899e12e7ec86\">homonymous</span> <span class=\"customMeta\" data-dictid=\"e0b79d0fde16927771965173ff3031\">quadrantanopia</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Associated Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Memory loss</li>\n<li>Hearing loss</li>\n<li>Auditory hallucinations</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Contralateral hemiplegia</li>\n<li>Hemianesthesia</li>\n<li>Optokinetic nystagmus</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"275\" src=\"https://image.prepladder.com/content/Pk1nARXkMXiyb8hHfoPN1745317079.png\" width=\"275\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"152\" src=\"https://image.prepladder.com/content/YkQJVVX4Pf4BLthw81mR1745317084.png\" width=\"281\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A male patient presented to the emergency room with seizures. He has a history of fever, headache, and confusion. An MRI brain was done, and it showed inflammation involving the bitemporal lobe. What is the most likely etiology for this presentation?", "options": [{"label": "A", "text": "Cytomegalovirus", "correct": false}, {"label": "B", "text": "Toxoplasma gondii", "correct": false}, {"label": "C", "text": "Herpes simplex virus", "correct": true}, {"label": "D", "text": "Mycobacterium tuberculosis", "correct": false}], "correct_answer": "C. Herpes simplex virus", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/wXxKq1GTlkJ95fi4DbdB1745317164.png"], "explanation": "<p>Correct Answer C - Herpes simplex virus</p>\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>CSF findings in <span class=\"customMeta\" data-dictid=\"7d8f74eaae16927771928214d10c17\">meningitis</span> </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Glucose (mg/dL)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Protein (mg/dL)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>WBC (per µL)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Bacterial </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">&lt;40</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">&gt;45</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">&gt;1000</p>\n<p style=\"text-align:center\">(PMNs)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Viral </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Normal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">20-80</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">25-500</p>\n<p style=\"text-align:center\">(Predominantly lymphocytes)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>TB </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">&lt;50 in 75% cases</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">100-200</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">25-100</p>\n<p style=\"text-align:center\">(Predominantly lymphocytes)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Fungal </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">↓ to normal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">150-300</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">40-600</p>\n<p style=\"text-align:center\">(Lymphocytes or PMNs, depending on the <span class=\"customMeta\" data-dictid=\"f616aee08b169277718361438e1a91\">causative</span> organism)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Parasitic </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Normal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">50-200</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">150-2000</p>\n<p style=\"text-align:center\">(↑↑ Eosinophils) (≥50%)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 2-month-old infant is brought to the OPD with a parietal swelling present since birth. The X-ray image is given below. What could be the probable diagnosis?", "options": [{"label": "A", "text": "Subgaleal hematoma", "correct": false}, {"label": "B", "text": "Cephalohematoma", "correct": true}, {"label": "C", "text": "Caput succedaneum", "correct": false}, {"label": "D", "text": "Enecephalocele", "correct": false}], "correct_answer": "B. Cephalohematoma", "question_images": ["https://image.prepladder.com/notes/IrL95MdbB9d1n2UFCjbh1745913268.png"], "explanation_images": ["https://image.prepladder.com/content/lqIT8CVniFBcfpaA8jn01745317400.png", "https://image.prepladder.com/notes/2CatLN1TXhFMsHk2HvGS1745913270.png", "https://image.prepladder.com/notes/WwwhT42Y2w7dmD8OhAAk1745913271.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:629px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Characteristic</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Caput Succedaneum</strong></p>\n<p><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Cephalohematoma</strong></p>\n<p><strong>(Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Incidence</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Common</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Less common</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Subcutaneous plane</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Over <span class=\"customMeta\" data-dictid=\"51df38de3d1692777194ced4c4bab5\">parietal</span> bones, between the skull and periosteum.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Time of Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Maximum size and firmness at birth.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Develops during the 1st few hours of life. Increasing size for 12-24 hours and then stable.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Time Course</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Softens progressively from birth.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Takes 3-6 weeks to resolve, but may resolve within 2-3 days.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Characteristic Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Diffuse Circular boggy area of oedema with indistinct borders.</li>\n<li>Often with overlying ecchymosis</li>\n<li>Crosses <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> line</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Well-circumscribed fluid-filled mass.</li>\n<li>Does not cross the <span class=\"customMeta\" data-dictid=\"90dcd6e02316927771990a5c253ff7\">suture</span> line</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Association</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>None</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Linear skull <span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\">fracture</span> (5-25%); hyperbilirubinemia</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"AMH Sheikh\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://commons.wikimedia.org/wiki/File:Scalp_hematomas.jpg\" data-tags=\"\" height=\"288\" src=\"https://image.prepladder.com/content/lqIT8CVniFBcfpaA8jn01745317400.png\" width=\"865\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old diabetic woman presents with painless loss of vision. The ocular findings are shown in the image below. What is the likely diagnosis and management for this patient?", "options": [{"label": "A", "text": "Zonular cataract and lensectomy", "correct": false}, {"label": "B", "text": "Rosette cataract and sugar control", "correct": false}, {"label": "C", "text": "Sunflower cataract and lesion extraction", "correct": false}, {"label": "D", "text": "Immature senile cataract and phacoemulsification with IOL", "correct": true}], "correct_answer": "D. Immature senile cataract and phacoemulsification with IOL", "question_images": ["https://image.prepladder.com/notes/URe28TXKFEpLrTFTIQ1W1745909933.png"], "explanation_images": ["https://image.prepladder.com/content/IWP4nxdc9hpL8oFieEkK1745317430.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Type of Cataract</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Visual Impact</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cuneiform <span class=\"customMeta\" data-dictid=\"f13bb39af816927771989e731b0502\">Senile</span> Cortical Cataract</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Wedge-shaped opacities</strong> with clear areas in between.</li>\n<li>Extends from <strong>periphery to center</strong>.</li>\n<li>First appears in the lower <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> quadrant. Present in both <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> cortex.</li>\n<li>The <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> spoke-like pattern of opacities is seen.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Visual disturbances are noted at a comparatively late stage (since it starts at the periphery).</li>\n<li>Vision improves in bright light with contracted pupils.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cupuliform <span class=\"customMeta\" data-dictid=\"f13bb39af816927771989e731b0502\">Senile</span> Cortical <span class=\"customMeta\" data-dictid=\"781e6a5a991692777183252720baad\">Cataract</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Saucer-shaped opacities</strong> are typically in the central part of the <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"cab8787ce916927771852a7e72f34d\">cortex</span> (<strong>posterior <span class=\"customMeta\" data-dictid=\"550fa75ff216927771992c0987c58e\">subcapsular</span> cataract).</strong></li>\n<li>Extends from center to periphery.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Causes an early loss of visual acuity.- Due to the involvement of the nodal point</li>\n<li>Glares seen in PSC</li>\n<li>Better vision in dim light with dilated pupils.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Characteristics</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1. Stage of Lamellar Separation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Earliest stage of <span class=\"customMeta\" data-dictid=\"f13bb39af816927771989e731b0502\">senile</span> cataract</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Formation of vacuoles and water clefts within the cortex</li>\n<li>Reversible change</li>\n<li>Can only be demonstrated by <span class=\"customMeta\" data-dictid=\"7fbb9ec5b716927771981c011f4299\">slit</span> lamp examination</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>2. Stage of Incipient Cataract</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Detectable opacities with clear areas present between. Causes visual disturbances.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cuneiform type:</strong></p>\n<ul>\n<li>Wedge-shaped opacities, extending from the <span class=\"customMeta\" data-dictid=\"2056156e8d169277718799b9e86725\">equator</span> appear as <span class=\"customMeta\" data-dictid=\"4fff084ff9169277719765c9d85a8e\">radial</span> spoke-like opacities.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cupuliform type:</strong></p>\n<ul>\n<li>Saucer-shaped <span class=\"customMeta\" data-dictid=\"a8eadab50316927771948be0cc91ca\">opacity</span> in the central <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> cortex.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>3. Immature <span class=\"customMeta\" data-dictid=\"f13bb39af816927771989e731b0502\">Senile</span> <span class=\"customMeta\" data-dictid=\"781e6a5a991692777183252720baad\">Cataract</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Progression of opacification</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Iris shadow visible </strong>(clear <span class=\"customMeta\" data-dictid=\"cab8787ce916927771852a7e72f34d\">cortex</span> visible) -Iris Shadow present here due to opacities + clear areas</li>\n<li>Can progress to <span class=\"customMeta\" data-dictid=\"efbe4dea2e1692777190fabea13765\">Intumescent</span> <span class=\"customMeta\" data-dictid=\"781e6a5a991692777183252720baad\">Cataract</span> leading to the shallow <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> chamber.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>4. <span class=\"customMeta\" data-dictid=\"0472620c171692777192c655af9c57\">Mature</span> <span class=\"customMeta\" data-dictid=\"f13bb39af816927771989e731b0502\">Senile</span> <span class=\"customMeta\" data-dictid=\"781e6a5a991692777183252720baad\">Cataract</span> (aka <span class=\"customMeta\" data-dictid=\"efbe4dea2e1692777190fabea13765\">intumescent</span> cataract)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Complete <span class=\"customMeta\" data-dictid=\"990cbfd3111692777194c6967ee125\">opacification</span> of cortex</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>The lens appears pearly white</li>\n<li>Referred to as a \"ripe cataract\"</li>\n<li>No <span class=\"customMeta\" data-dictid=\"6e53fc929616927771900fbab3617f\">iris</span> shadow as the whole lens is opacified with a chalky white color</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>5. Hypermature <span class=\"customMeta\" data-dictid=\"f13bb39af816927771989e731b0502\">Senile</span> <span class=\"customMeta\" data-dictid=\"781e6a5a991692777183252720baad\">Cataract</span> (HMSC)</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Advanced stage of <span class=\"customMeta\" data-dictid=\"781e6a5a991692777183252720baad\">cataract</span> beyond maturity</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Morgagnian Hypermature Cataract: </strong></p>\n<ul>\n<li>Cortex liquefies</li>\n<li>Nucleus sinks to the bottom</li>\n<li>Bag of <span class=\"customMeta\" data-dictid=\"70da66640f16927771920de556da59\">milky</span> fluid appearance</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Jesse Vislisel\" data-hash=\"\" data-license=\"CC BY-NC-ND 3.0\" data-source=\"Morgagnian cataract. EyeRounds.org: Online Ophthalmic Atlas (uiowa.edu)\" data-tags=\"\" height=\"184\" src=\"https://image.prepladder.com/content/IWP4nxdc9hpL8oFieEkK1745317430.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sclerotic Hypermature Cataract: </strong></p>\n<ul>\n<li>The <span class=\"customMeta\" data-dictid=\"cab8787ce916927771852a7e72f34d\">cortex</span> disintegrates, lens and <span class=\"customMeta\" data-dictid=\"54635b1bf01692777183247ecff5e0\">capsule</span> shrink.</li>\n<li>Deep <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> chamber</li>\n<li>Iridodonesis may be present.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A male patient presents with sensory loss and weakness of limbs for 3 months. He also has angular stomatitis. On examination, there is loss of proprioception, vibration sensations, UMN-type lower limb weakness, and absent ankle reflex. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Extradural cord compression", "correct": false}, {"label": "B", "text": "Amyotrophic lateral sclerosis", "correct": false}, {"label": "C", "text": "Multiple sclerosis", "correct": false}, {"label": "D", "text": "Subacute combined degeneration of the cord", "correct": true}], "correct_answer": "D. Subacute combined degeneration of the cord", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/9wvg5iydcOXxkZYRf1g51745917379.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 5-year-old boy presents with a small nodule on the sclera as shown in the image below. What is the likely diagnosis?", "options": [{"label": "A", "text": "Pterygium", "correct": false}, {"label": "B", "text": "Pinguecula", "correct": false}, {"label": "C", "text": "Dermolipoma", "correct": false}, {"label": "D", "text": "Dermoid cyst", "correct": true}], "correct_answer": "D. Dermoid cyst", "question_images": ["https://image.prepladder.com/content/zP02tClRYyxvoBukBui71745317566.png"], "explanation_images": ["https://image.prepladder.com/content/536KHwWNCaaKHRNGAJVn1745317662.png", "https://image.prepladder.com/content/PEMXYr1hKIXpQ0G28NfY1745317671.png", "https://image.prepladder.com/content/DVU6cGAKTPPEjRLG5D0z1745317679.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented with abdominal pain and sterile pyuria, and the x-ray showed the following features. What is the likely diagnosis?", "options": [{"label": "A", "text": "Putty kidney", "correct": true}, {"label": "B", "text": "Staghorn calculus", "correct": false}, {"label": "C", "text": "Nephrocalcinosis", "correct": false}, {"label": "D", "text": "Psoas calcification", "correct": false}], "correct_answer": "A. Putty kidney", "question_images": ["https://image.prepladder.com/content/od9sF9t3CToSaCrZqoRo1745317467.png"], "explanation_images": ["https://image.prepladder.com/content/aiXnBG0tEm0W305KBiPV1745317815.png", "https://image.prepladder.com/content/Aft7MzfZWjw6KSe9TLIk1745317770.png", "https://image.prepladder.com/notes/4EiUw3dGdj6COaXmUS3T1745915842.jpg", "https://image.prepladder.com/content/vqaMJEIjnXZXb5v8Ow0P1745317770.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:1000px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Staghorn Calculus</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Putty <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">Kidney</span> (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Medullary Nephrocalcinosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Large, branching stone <span class=\"customMeta\" data-dictid=\"52edf0af4d1692777202dd1a490884\">filling</span> the <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"c25071fa3816927771955eeaf9d45e\">pelvis</span> and calyces, resembling the shape of a staghorn.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tissue damage in the <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> by TB leads to dystrophic calcification. Indicates end-stage <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> TB.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Calcium deposition within the <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"53abb386551692777192c4d1f1f5ed\">medulla</span> (inner kidney).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Struvite stones formed from <span class=\"customMeta\" data-dictid=\"4d7ed0baae169277719199f6e9ab7b\">magnesium</span> <span class=\"customMeta\" data-dictid=\"3719e878a4169277718109b2d3f67e\">ammonium</span> <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> due to infection with urease-producing bacteria (e.g., Klebsiella, Proteus)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Renal <span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\">tuberculosis</span> leads to <span class=\"customMeta\" data-dictid=\"2334b7498b1692777188fa8b2eee36\">granuloma</span> formation causing necrosis, cavitation, <span class=\"customMeta\" data-dictid=\"21e2d5a70616927772021fcdec0ca9\">fibrosis</span> and <span class=\"customMeta\" data-dictid=\"329b77e4b11692777199930404f75c\">stricture</span> formation.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Metabolic disturbances (e.g., hyperparathyroidism, sarcoidosis, <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"98d387b7bd1692777201278b27be72\">tubular</span> acidosis, <span class=\"customMeta\" data-dictid=\"0a36e18386169277719259641cf29b\">medullary</span> <span class=\"customMeta\" data-dictid=\"1f8d123d5a16927771996d6f75145f\">sponge</span> <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> disease) leading to <span class=\"customMeta\" data-dictid=\"a1ee14c673169277718351bfe6afd4\">calcification</span> of the <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> medulla</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Imaging Characteristics</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Radio-opaque, visible on CT. They often <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> rapidly; fill the <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"c25071fa3816927771955eeaf9d45e\">pelvis</span> and extend into calyces. <strong>(Option B ruled out)</strong></p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Nephron\" data-hash=\"\" data-license=\"CC BY-SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Diffuse_proliferative_nephritis#/media/File:Diffuse_proliferative_lupus_nephritis_-_high_mag.jpg\" data-tags=\"\" height=\"300\" src=\"https://image.prepladder.com/content/aiXnBG0tEm0W305KBiPV1745317815.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Appears as a <span class=\"customMeta\" data-dictid=\"61f84221371692777191a8e70c449c\">lobulated</span> mass of calcified tissue on CT scans, resembling \"putty\"; indicating a non-functioning kidney.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Detected on plain radiographs, ultrasound, and CT. USG and CT are very specific and hence useful even in mild cases</p>\n<ul>\n<li>USG- <span class=\"customMeta\" data-dictid=\"165957ab9c16927771899a331e37b0\">hyperechoic</span> <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"e46d46c1521692777194d02f11f83b\">parenchyma</span> with <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> <span class=\"customMeta\" data-dictid=\"54d290087e1692777180c6cc682930\">acoustic</span> shadowing.</li>\n</ul>\n<p> </p>\n<ul>\n<li>CT- High-density <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"e46d46c1521692777194d02f11f83b\">parenchyma</span> in the <span class=\"customMeta\" data-dictid=\"53abb386551692777192c4d1f1f5ed\">medulla</span> <strong>(Option C ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The eye examination of a 20-year-old male shows a golden ring on the cornea. What of the following is the investigation of choice to diagnose the condition?", "options": [{"label": "A", "text": "Alpha-1-antitrypsin", "correct": false}, {"label": "B", "text": "Alpha-fetoprotein", "correct": false}, {"label": "C", "text": "Serum iron", "correct": false}, {"label": "D", "text": "Serum ceruloplasmin", "correct": true}], "correct_answer": "D. Serum ceruloplasmin", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A woman with endometrial carcinoma is undergoing radiotherapy. Which of the following is true?", "options": [{"label": "A", "text": "Intensity is inversely proportional to the square of the distance from the source", "correct": true}, {"label": "B", "text": "Small blood vessels are most radioresistant", "correct": false}, {"label": "C", "text": "Rapidly proliferating cells are most radioresistant", "correct": false}, {"label": "D", "text": "Small intestinal mucosa is most radio-resistant", "correct": false}], "correct_answer": "A. Intensity is inversely proportional to the square of the distance from the source", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old female patient came with complaints of chest pain, palpitation, and shortness of breath. On examination, a mid-diastolic murmur was heard, and a prominent 'a' wave was found on JVP. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Mitral stenosis", "correct": false}, {"label": "B", "text": "Tricuspid stenosis", "correct": true}, {"label": "C", "text": "Mitral regurgitation", "correct": false}, {"label": "D", "text": "Tricuspid regurgitation", "correct": false}], "correct_answer": "B. Tricuspid stenosis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Features of Murmur</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Associated Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>JVP Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Aortic <span class=\"customMeta\" data-dictid=\"9e495cf9cf16927771975bf315a060\">Regurgitation</span> (AR)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Incomplete <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> of the aortic valve, causing <span class=\"customMeta\" data-dictid=\"e38ca8e6931692777197ee6a68ac56\">retrograde</span> flow into LV.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Type: Diastolic decrescendo murmur.</li>\n<li>Location: Best heard at left sternal border (3rd-4th ICS).</li>\n<li>Features: High-pitched, decrescendo.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Bounding pulses</li>\n<li>Wide pulse pressure</li>\n<li>Water-Hammer pulse</li>\n<li>Heart failure symptoms.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal or minimally elevated JVP unless associated with heart failure.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Aortic <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">Stenosis</span> (AS)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Narrowing of the aortic valve, obstructing LV outflow.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Type: <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">Systolic</span> <span class=\"customMeta\" data-dictid=\"3b69bda4d21692777187109c85a27e\">ejection</span> murmur.</li>\n<li>Location: Best heard at right upper sternal border (2nd ICS), radiates to carotids.</li>\n<li>Features: Crescendo-decrescendo.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Angina</li>\n<li>Syncope</li>\n<li>Left <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> hypertrophy</li>\n<li>Paradoxical S2 splitting.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Normal JVP unless severe.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Mitral <span class=\"customMeta\" data-dictid=\"9e495cf9cf16927771975bf315a060\">Regurgitation</span> (MR) (Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Incomplete <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> of the <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> valve, causing <span class=\"customMeta\" data-dictid=\"bbee2f1b011692777182d9b84068ec\">backflow</span> from LV to LA.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Type: <span class=\"customMeta\" data-dictid=\"529e0aff291692777194cbe766b6de\">Pansystolic</span> murmur.</li>\n<li>Location: Best heard at the apex, radiates to the axilla.</li>\n<li>Intensity: <span class=\"customMeta\" data-dictid=\"d4ae50897e16927771884b5c46ba7d\">Grade</span> II-IV, soft/absent S1 in chronic cases.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Dyspnea</li>\n<li>Fatigue</li>\n<li>Orthopnea</li>\n<li>Atrial fibrillation.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated JVP, prominent V wave due to <span class=\"customMeta\" data-dictid=\"00f5a32045169277719710bd9dd167\">regurgitant</span> flow.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Mitral <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">Stenosis</span> (MS) (Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Narrowing of the <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> valve, obstructing flow from LA to LV.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Type: Diastolic rumbling murmur.</li>\n<li>Location: Best heard at <span class=\"customMeta\" data-dictid=\"2d7ea2751316927771816ceb31afee\">apex</span> in left <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> <span class=\"customMeta\" data-dictid=\"f518295be51692777185698bd9b0fd\">decubitus</span> position.</li>\n<li>Features: Low-pitched, with an <span class=\"customMeta\" data-dictid=\"bcee4434ec169277719487e088cf42\">opening snap</span> after S2.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Dyspnea</li>\n<li>Pulmonary hypertension</li>\n<li>Right-sided heart failure</li>\n<li>Atrial fibrillation.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated JVP with prominent \"a\" wave due to increased atrial pressure.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Tricuspid <span class=\"customMeta\" data-dictid=\"9e495cf9cf16927771975bf315a060\">Regurgitation</span> (TR) (Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Incomplete <span class=\"customMeta\" data-dictid=\"2b4569285f1692777184282b1ca3f1\">closure</span> of the <span class=\"customMeta\" data-dictid=\"3ab13cdf64169277720085e2ebef1c\">tricuspid</span> valve, causing <span class=\"customMeta\" data-dictid=\"bbee2f1b011692777182d9b84068ec\">backflow</span> into the right atrium.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Type: <span class=\"customMeta\" data-dictid=\"529e0aff291692777194cbe766b6de\">Pansystolic</span> murmur.</li>\n<li>Location: Best heard at the lower left sternal border.</li>\n<li>Features: Holosystolic, blowing murmur.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hepatomegaly</li>\n<li>Ascites</li>\n<li>Edema</li>\n<li>Right-sided heart failure.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated JVP with prominent \"v\" wave due to <span class=\"customMeta\" data-dictid=\"bbee2f1b011692777182d9b84068ec\">backflow</span> into the right atrium.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Tricuspid <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">Stenosis</span> (TS)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Narrowing of the <span class=\"customMeta\" data-dictid=\"3ab13cdf64169277720085e2ebef1c\">tricuspid</span> valve, obstructing flow from RA to RV.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Type: Diastolic murmur.</li>\n<li>Location: Best heard at the lower left sternal border.</li>\n<li>Features: Low-pitched rumbling murmur.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Fatigue</li>\n<li>Hepatomegaly</li>\n<li>Ascites</li>\n<li>Peripheral edema.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated JVP with prominent \"a\" wave due to increased atrial pressure.</p>\n</td>\n</tr>\n</tbody>\n\n<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Murmur Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Subtype</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Conditions <span class=\"customMeta\" data-dictid=\"da6b4ea38d169277719384b53c8f45\">murmur</span> heard</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Additional points</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Systolic Murmurs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ejection <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">Systolic</span> Murmur</p>\n<p><strong>(HAP</strong>py<strong>)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Pulmonary Stenosis</li>\n<li>Aortic Stenosis</li>\n<li>HOCM</li>\n</ul>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Early <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> murmur</strong> seen with <span class=\"customMeta\" data-dictid=\"62b9af909d1692777194cd004f10f4\">papillary</span> muscle dysfunction.</li>\n<li><strong>Late <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">systolic</span> murmur</strong> is seen in small VSD and <span class=\"customMeta\" data-dictid=\"d93de7238d16927771922b27cb6086\">mitral</span> <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">valve</span> <span class=\"customMeta\" data-dictid=\"c49cc1bac4169277719692da7af2cc\">prolapse</span> (MVP)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Pan <span class=\"customMeta\" data-dictid=\"cf69f5256416927771991c21f264ae\">Systolic</span> Murmur<strong>(MTV)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Mitral regurgitation</li>\n<li>Tricuspid regurgitation</li>\n<li>Ventricular septal defect</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Diastolic Murmurs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Early Diastolic Murmur<strong> (GAP)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>G</strong>raham Steell murmur</li>\n<li><strong>A</strong>ortic <span class=\"customMeta\" data-dictid=\"9e495cf9cf16927771975bf315a060\">regurgitation</span> (mild)</li>\n<li><strong>P</strong>ulmonary <span class=\"customMeta\" data-dictid=\"9e495cf9cf16927771975bf315a060\">regurgitation</span> (mild)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Along with <span class=\"customMeta\" data-dictid=\"cdf4a197dd16927771881a652c8328\">hemodynamic</span> changes the characteristics of flow also changes</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Mid-Diastolic Murmur</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Carey Coombs murmur</li>\n<li>Austin Flint murmur</li>\n<li>Mitral stenosis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Flow <span class=\"customMeta\" data-dictid=\"da6b4ea38d169277719384b53c8f45\">murmur</span> may <span class=\"customMeta\" data-dictid=\"efaf9e0192169277719278711f7f74\">mimic</span> <span class=\"customMeta\" data-dictid=\"b825d986e21692777192406626fe87\">mid-diastolic</span> murmur</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Continuous Murmurs</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Patent <span class=\"customMeta\" data-dictid=\"7a6864e97b169277718602072817ee\">ductus</span> arteriosus</li>\n<li>Aortopulmonary window</li>\n<li>Ruptured <span class=\"customMeta\" data-dictid=\"b0046463171692777198e0beea83e7\">sinus</span> of Valsalva aneurysm</li>\n<li>Coronary <span class=\"customMeta\" data-dictid=\"3c19af349e16927771825f314a4a84\">arteriovenous</span> fistula</li>\n<li>Cervical <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> hum</li>\n<li>Anomalous left <span class=\"customMeta\" data-dictid=\"bc8bc758371692777185eff2ccabb7\">coronary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> origin</li>\n<li>Mammary <span class=\"customMeta\" data-dictid=\"e4f948abaf16927771989891c1676d\">souffle</span> of pregnancy</li>\n<li>Bronchial <span class=\"customMeta\" data-dictid=\"4de12d1ef31692777184db1d11c6bd\">collateral</span> circulation</li>\n<li>Intercostal or <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"3c19af349e16927771825f314a4a84\">arteriovenous</span> fistula</li>\n<li>Peripheral <span class=\"customMeta\" data-dictid=\"5ebe3b1fbd1692777196b3ced12100\">pulmonic</span> stenosis</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Causes are diverse and involve persistent communication between <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> and <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> circulation.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The patient has a history of fever and cough for the last 5 days. The examination findings show crepitations, and a chest X-ray is shown below. Based on these details, what is the likely diagnosis for this patient?", "options": [{"label": "A", "text": "Apical segment of Right lower lobe consolidation", "correct": false}, {"label": "B", "text": "Right middle lobe consolidation", "correct": true}, {"label": "C", "text": "Posterior segment of right lower lobe consolidation", "correct": false}, {"label": "D", "text": "Loculated pleural effusion", "correct": false}], "correct_answer": "B. Right middle lobe consolidation", "question_images": ["https://image.prepladder.com/content/cCPqXpK2Q3xIl8I4Yexj1745317998.png"], "explanation_images": ["https://image.prepladder.com/content/IIvtc9G4OM9RkNqO3f041745318039.png", "https://image.prepladder.com/content/k1pb1oU8bmtBk3kz87Dn1745318039.png", "https://image.prepladder.com/content/YnGj31o0t6FTaj7zwo211745318039.png", "https://image.prepladder.com/content/WO4roO8I2xVF0VCRkGCM1745318039.png", "https://image.prepladder.com/content/cY4gIwtkn0u235mq2wZ41745318039.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What dye and filter are used in the image, as shown below?", "options": [{"label": "A", "text": "Lissamine dye green filter", "correct": false}, {"label": "B", "text": "Lissamine dye cobalt blue filter", "correct": false}, {"label": "C", "text": "Fluorescein dye green filter", "correct": false}, {"label": "D", "text": "Fluorescein dye cobalt blue filter", "correct": true}], "correct_answer": "D. Fluorescein dye cobalt blue filter", "question_images": ["https://image.prepladder.com/content/jNgnNpHvcMVWrsaLSYwY1745317963.png"], "explanation_images": ["https://image.prepladder.com/content/qmK6yIpcNCcDHOcMguK11745318011.png", "https://image.prepladder.com/content/3kT31MxflIc4zru7wcyP1745318019.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient who is a known case of hypertension on multiple antihypertensive medications came to the OPD. His ECG finding is given below. Which of the following drugs is responsible for the ECG finding?", "options": [{"label": "A", "text": "Prazosin", "correct": false}, {"label": "B", "text": "Metoprolol", "correct": false}, {"label": "C", "text": "Hydrochlorothiazide", "correct": false}, {"label": "D", "text": "Spironolactone", "correct": true}], "correct_answer": "D. Spironolactone", "question_images": ["https://image.prepladder.com/notes/gRbN89SetAeyoIgYcbHk1745917379.png"], "explanation_images": ["https://image.prepladder.com/notes/pIVGNMUF6ThzYzbXA0Gu1745917381.png", "https://image.prepladder.com/notes/DBtf3Gs1PVgwbhyE6uDj1745917954.png"], "explanation": "<p>Correct Answer D) Spironolactone</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Serum <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">Potassium</span> Level (mEq/L)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>ECG Changes</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">5.5–6.5</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Tall, peaked T waves</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">6.5–7.5</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Loss of P waves</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">7.0–8.0</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Widened QRS complex</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">&gt; 8.0</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\">Sine wave pattern</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A newborn presented with chest retractions, dyspnea, and lethargy. The pediatrician diagnosed the baby with respiratory distress syndrome. This occurs due to a deficiency of:", "options": [{"label": "A", "text": "Dipalmitoyl inositol", "correct": false}, {"label": "B", "text": "Lecithin", "correct": true}, {"label": "C", "text": "Sphingomyelin", "correct": false}, {"label": "D", "text": "Dipalmitoylphosphatidylethanolamine", "correct": false}], "correct_answer": "B. Lecithin", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/hsenWdiSfN5yo7gtEt1B1745318297.png", "https://image.prepladder.com/notes/EbAw7cdizGzn5FTd6D181745912601.png", "https://image.prepladder.com/content/Qxmw7xFfuxTC1SYy1Ze41745318297.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following refractive errors is associated with the image given below?", "options": [{"label": "A", "text": "Presbyopia", "correct": false}, {"label": "B", "text": "Astigmatism", "correct": true}, {"label": "C", "text": "Hypermetropia", "correct": false}, {"label": "D", "text": "Myopia", "correct": false}], "correct_answer": "B. Astigmatism", "question_images": ["https://image.prepladder.com/notes/uRca3rtCN5JwuvQjsfA71745909935.png"], "explanation_images": ["https://image.prepladder.com/content/FoKtsEa0rsDCvdqhKDuq1745318252.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Regular Astigmatism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Refractive power changes uniformly from one <span class=\"customMeta\" data-dictid=\"d2266722801692777192382c2b5902\">meridian</span> to another. There are 2 principal meridians.\n\t\t\t\t<ul>\n<li>Oblique Astigmatism- two principal meridians are not <span class=\"customMeta\" data-dictid=\"6f4a4d02ec169277718995b05c1d26\">horizontal</span> and vertical but are at right angles to each other (e.g., 45° and 135°).</li>\n<li>Bioblique Astigmatism- two principal meridians are not at right angles to each other (e.g., one at 30° and the other at 100°).</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Irregular Astigmatism</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Irregular change in <span class=\"customMeta\" data-dictid=\"cae831e44316927771973fa5e13fd7\">refractive</span> power in different meridians, with multiple meridians that do not admit geometrical analysis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 10-year-old child weighing 30 kg presents with a history of loose stools for 2 days. On examination, there is severe dehydration. Laboratory investigations are as follows. What is the initial management as per ISPAD guidelines? RBS 550 mg/dL pH 7.01 Na+ 158 mEq/L Urine glucose 3+", "options": [{"label": "A", "text": "Manage ABC, NS 20 mL/kg and start insulin after 1 hour", "correct": true}, {"label": "B", "text": "Manage ABC, NS 20 mL/kg along with insulin 0.1 IU/kg/hr", "correct": false}, {"label": "C", "text": "Manage ABC, NS 10 mL/kg along with insulin 0.1 IU/kg/hr", "correct": false}, {"label": "D", "text": "Manage ABC, NS 10 mL/kg and start insulin after 1 hour", "correct": false}], "correct_answer": "A. Manage ABC, NS 20 mL/kg and start insulin after 1 hour", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/KxW9OZlKXkX5SER7XRFX1745912603.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>DKA Management in Children</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<h4><strong>Immediate Management (First Hour):</strong></h4>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rapid Assessment:</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Evaluate the child's vital signs (heart rate, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> rate, blood pressure) and weight.</li>\n<li>Assess GCS and check for signs of dehydration.</li>\n<li>Obtain blood samples for urgent measurement of blood glucose, blood beta-hydroxybutyrate (BHB) if available, <span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\">venous</span> pH, electrolytes (including bicarbonate), <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"38d4be106e169277720105b006c26b\">urea</span> nitrogen, and creatinine.</li>\n<li><strong>Serum BHB concentration</strong>: Most precise approach to measuring the severity of DKA</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Establish IV Access:</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Place two large-bore <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> IV lines. Central lines are generally avoided (risk of thrombosis) unless necessary.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Initial Fluid Resuscitation</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Administer a <span class=\"customMeta\" data-dictid=\"8d138d554c16927771835be732558c\">bolus</span> of <strong>0.9% <span class=\"customMeta\" data-dictid=\"894da1dfe6169277719871d7210619\">saline</span> at a rate of 10-20 ml/kg over 20-30 minutes</strong> to restore <span class=\"customMeta\" data-dictid=\"f3739d892c1692777184b2e134615c\">circulatory</span> volume and address dehydration.</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>After First Hour</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Initiate <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">Insulin</span> Therapy</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Start an<strong> <span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\">intravenous</span> <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> <span class=\"customMeta\" data-dictid=\"3562d699c516927771909a426ea8ef\">infusion</span> at 0.05-0.1 U/kg/h</strong>, typically one hour after initiating fluids.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Continue Fluid Therapy</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>After the initial bolus, continue fluid replacement with 0.45% to 0.9% saline, to replace the estimated fluid deficit over 24 to 48 hours. Adjust fluids based on clinical status and laboratory values.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Monitoring and Replacing Electrolytes</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Begin<strong> <span class=\"customMeta\" data-dictid=\"a995a613a016927771969d4395dc80\">potassium</span> replacement </strong>once <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> output is confirmed as <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> causes K+ entry into cells, leading to hypokalemia.</li>\n<li>Monitor vital signs, GCS, fluid balance, and <span class=\"customMeta\" data-dictid=\"89e3252d5b16927771833fb9b432ae\">capillary</span> blood <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> every hour.</li>\n<li>Reassess electrolytes, blood glucose, blood <span class=\"customMeta\" data-dictid=\"38d4be106e169277720105b006c26b\">urea</span> nitrogen, calcium, magnesium, phosphate, blood gases, and BOHB every two hours if available.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<h4><strong>Transition Phase (6-24 Hours):</strong></h4>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gradual Reduction of IV Fluids and</p>\n<p>transition to <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> Insulin</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>As DKA resolves and the child can tolerate oral intake, gradually reduce IV fluids while maintaining hydration.</li>\n<li>Transition to <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> once pH &gt; 7.30, <span class=\"customMeta\" data-dictid=\"2311c3b4ac16927771831d4c919043\">bicarbonate</span> &gt; 18 mmol/L, and BOHB &lt; 1 mmol/L.</li>\n<li>Administer the first <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> dose 15-30 minutes before discontinuing the IV <span class=\"customMeta\" data-dictid=\"b47c9c6144169277719010eaa1a0ee\">insulin</span> infusion.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 78-year-old woman presents with a progressive decline in daily activity. She gives a history of convulsions and visual hallucinations. She does not talk to anyone and keeps looking at the sky. Pathological examination shows the presence of Lewy bodies within the neurons. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Parkinson's disease", "correct": true}, {"label": "B", "text": "Prion disease", "correct": false}, {"label": "C", "text": "Huntington's chorea", "correct": false}, {"label": "D", "text": "Alzheimer's disease", "correct": false}], "correct_answer": "A. Parkinson's disease", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Type of Dementia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Clinical Findings</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Alzheimer's Disease (AD) (Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Most common type of dementia, characterized by <span class=\"customMeta\" data-dictid=\"51ad856e041692777181f80c9d507a\">amyloid</span> plaques and <span class=\"customMeta\" data-dictid=\"349c5a4f5d169277720062d348498a\">tau</span> tangles in the brain.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Memory loss, especially short-term memory</li>\n<li>Disorientation</li>\n<li>Language difficulties</li>\n<li>Impaired judgment and reasoning</li>\n<li>Personality changes</li>\n<li>Progressive cognitive decline2</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Vascular Dementia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Results from damage to blood vessels in the brain, leading to <span class=\"customMeta\" data-dictid=\"10c83adb331692777197f775bec1aa\">reduced</span> blood flow. Often follows a stroke or series of small strokes.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Stepwise <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> of cognitive decline</li>\n<li>Memory loss</li>\n<li>Impaired executive function</li>\n<li>Gait disturbances</li>\n<li>Personality and mood changes</li>\n<li>Signs of previous strokes (e.g., hemiparesis)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Lewy Body Dementia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Caused by <span class=\"customMeta\" data-dictid=\"458e050fdc16927771809854c9fd53\">abnormal</span> protein deposits (Lewy bodies) in the brain, affecting cognitive and motor functions.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Visual hallucinations</li>\n<li>Parkinsonism (e.g., tremor, rigidity)</li>\n<li>Cognitive fluctuations</li>\n<li>Memory impairment</li>\n<li>REM sleep behavior disorder</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Frontotemporal <span class=\"customMeta\" data-dictid=\"41cc5ad93c169277718553c6b948a3\">Dementia</span> (FTD)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Characterized by <span class=\"customMeta\" data-dictid=\"df4f1758e2169277718697ae66f3dd\">degeneration</span> in the <span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\">frontal</span> and <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> lobes, often with personality and behavioral changes.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Personality and behavior changes (e.g., disinhibition, apathy)</li>\n<li>Language difficulties (e.g., aphasia)</li>\n<li>Lack of empathy</li>\n<li>Impulsive behaviors</li>\n<li>Social withdrawal</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Mixed Dementia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A combination of Alzheimer's disease and <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> dementia. Common in elderly patients.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Symptoms of both Alzheimer's and <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> dementia</li>\n<li>Cognitive decline with stepwise progression</li>\n<li>Memory problems</li>\n<li>Behavioral changes</li>\n<li>Motor problems (e.g., <span class=\"customMeta\" data-dictid=\"053afdc7031692777187c2079a86a3\">gait</span> disturbances)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Parkinson's Disease Dementia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Occurs in patients with Parkinson's disease, typically years after motor symptoms begin.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Memory loss</li>\n<li>Cognitive impairment</li>\n<li>Attention deficits</li>\n<li>Executive dysfunction</li>\n<li>Visual hallucinations</li>\n<li>Parkinsonism (e.g., bradykinesia, tremor)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Huntington's Disease</strong></p>\n<p style=\"text-align:center\"><strong>(Option C)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Genetic disorder characterized by progressive motor, cognitive, and psychiatric decline.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Involuntary movements (chorea)</li>\n<li>Memory impairment</li>\n<li>Personality changes (e.g., irritability, depression)</li>\n<li>Impaired <span class=\"customMeta\" data-dictid=\"3820ba101416927771858fe257e119\">coordination</span> and motor function</li>\n<li>Progressive dementia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Creutzfeldt-Jakob Disease (CJD)</strong></p>\n<p style=\"text-align:center\"><strong>(Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Rare <strong>prion disease </strong>causing rapid neurodegeneration, often with fatal progression.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Rapid onset of dementia</li>\n<li>Motor symptoms (e.g., ataxia, myoclonus)</li>\n<li>Visual disturbances</li>\n<li>Psychiatric symptoms (e.g., depression)</li>\n<li>Death usually within 1-2 years</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Wernicke-Korsakoff Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Caused by <span class=\"customMeta\" data-dictid=\"b70d1dbde516927772000d7774d2a5\">thiamine</span> deficiency, often due to alcohol abuse. Can lead to brain damage and dementia.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Amnesia (anterograde and retrograde)</li>\n<li>Confabulation</li>\n<li>Ataxia</li>\n<li>Nystagmus</li>\n<li>Neurological abnormalities due to <span class=\"customMeta\" data-dictid=\"b70d1dbde516927772000d7774d2a5\">thiamine</span> deficiency</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Normal Pressure <span class=\"customMeta\" data-dictid=\"018823377416927771896f6aa736a4\">Hydrocephalus</span> (NPH)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A condition where <span class=\"customMeta\" data-dictid=\"7a1ae24f701692777187a7f60bbd9f\">excess</span> <span class=\"customMeta\" data-dictid=\"99a9bf133e1692777184ec4b1011fe\">cerebrospinal</span> fluid accumulates in the brain ventricles, leading to cognitive decline.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Gait disturbances (shuffling walk)</li>\n<li>Urinary incontinence</li>\n<li>Dementia</li>\n<li>Enlargement of the ventricles on brain imaging</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the probable diagnosis for an infant brought in with symptoms of excessive tear production, sensitivity to light, and blepharospasm?", "options": [{"label": "A", "text": "Congenital glaucoma", "correct": true}, {"label": "B", "text": "Congenital cataract", "correct": false}, {"label": "C", "text": "Congenital Dacryocystitis", "correct": false}, {"label": "D", "text": "Ophthalmia neonatorum", "correct": false}], "correct_answer": "A. Congenital glaucoma", "question_images": ["https://image.prepladder.com/notes/gByemb1KQMLAVnylMosP1745909938.png"], "explanation_images": ["https://image.prepladder.com/content/NpX79qa0eb1WBT6WU8eV1745318455.png", "https://image.prepladder.com/content/TFDv5L2PYbzkwR9DABw31745318460.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Primary <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">Congenital</span> Glaucoma</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Types</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1. <span class=\"customMeta\" data-dictid=\"04df903fe8169277719383126b1b02\">Newborn</span> glaucoma/ True <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> glaucoma</strong>: Elevated <span class=\"customMeta\" data-dictid=\"1ba26fe8171692777190a867ec47c7\">intraocular</span> pressure is present during <span class=\"customMeta\" data-dictid=\"1d5d2712dc169277719050154d38a1\">intrauterine</span> life, resulting in <strong>ocular <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">enlargement</span> at birth</strong>. (40% cases)</p>\n<p>Typically presents within the first month of life.</p>\n<p>Often associated with developmental anomalies of the <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> segment, such as primary <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> glaucoma, which can result from genetic mutations or other <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> conditions.</p>\n<p><strong>2. Infantile: ≤ 3 yrs of age</strong>-<strong> </strong>Infantile <span class=\"customMeta\" data-dictid=\"61e49875801692777188ad5edea804\">glaucoma</span> is labelled when the disease manifests prior to the child's third birthday</p>\n<p>Affects infants older than 1 month and children up to 3 years.</p>\n<p>Can also result from genetic factors or be secondary to other conditions like Sturge-Weber syndrome or other <span class=\"customMeta\" data-dictid=\"87356352bc169277719923fcc93329\">syndromic</span> associations.</p>\n<p><strong>3. Juvenile: &gt; 3 yrs of age</strong> who develop pressure rise after 3 years but before adulthood. Also known as Juvenile primary open angle glaucoma(POAG) usually occurs between 10 to 35 years of age.</p>\n<p><strong>Buphthalmos</strong>, meaning \"bull-like eyes,\" is a condition characterized by the <span class=\"customMeta\" data-dictid=\"41e56d9a54169277718724ff8c225f\">enlargement</span> of the eyeball. It typically manifests before the age of 3 years and results from the accumulation and <span class=\"customMeta\" data-dictid=\"b668aed705169277719744b6db8f8e\">retention</span> of <span class=\"customMeta\" data-dictid=\"0f0067663b16927771818fe253b3b9\">aqueous</span> humor.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathogenesis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Trabeculodysgenesis:</strong> Maldevelopment of the trabeculum and iridotrabecular <span class=\"customMeta\" data-dictid=\"9f0942c0b51692777190ee876713e5\">junction</span> from <span class=\"customMeta\" data-dictid=\"b00388be25169277719369b3ab059f\">neural</span> <span class=\"customMeta\" data-dictid=\"48528974ed1692777185cd29753db5\">crest</span> cells impairs <span class=\"customMeta\" data-dictid=\"0f0067663b16927771818fe253b3b9\">aqueous</span> outflow, causing elevated IOP.</li>\n<li><strong>Angle <span class=\"customMeta\" data-dictid=\"e50e29a57b16927771978b2f6cff3e\">Recess</span> Absence:</strong> The angle <span class=\"customMeta\" data-dictid=\"e50e29a57b16927771978b2f6cff3e\">recess</span> is absent, with the <span class=\"customMeta\" data-dictid=\"6e53fc929616927771900fbab3617f\">iris</span> inserting either flatly or concavely into the trabeculum.</li>\n<li><strong>Iris Insertion Types:</strong>\n<ul>\n<li><strong>Flat Insertion:</strong> Reveals the <span class=\"customMeta\" data-dictid=\"1be9f55b2d1692777184b9d813b17e\">ciliary</span> body and scleral spur.</li>\n<li><strong>Concave Insertion:</strong> Obscures the <span class=\"customMeta\" data-dictid=\"d523549f091692777198f5ec70ed9e\">scleral spur</span> and <span class=\"customMeta\" data-dictid=\"1be9f55b2d1692777184b9d813b17e\">ciliary</span> body.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Classic Triad:</strong> Lacrimation, photophobia, and blepharospasm; often accompanied by eye rubbing.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"S. Senthil, S. Badakere, Jonnadula Ganesh, Rashmi Krishnamurthy, Siddharth Dikshit, N. Choudhari, C. Garudadri, A. Mandal\" data-hash=\"\" data-license=\"Open access\" data-source=\"https://www.semanticscholar.org/paper/Profile-of-childhood-glaucoma-at-a-tertiary-center-Senthil-Badakere/bc27a485cc916e6c96e909f8d28a97ba8737b151\" data-tags=\"\" height=\"155\" src=\"https://image.prepladder.com/content/NpX79qa0eb1WBT6WU8eV1745318455.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>Corneal Signs:</strong></p>\n<ul>\n<li><strong>Oedema:</strong> Early sign, may progress to permanent opacity.</li>\n<li><strong>Enlargement:</strong> Corneal <span class=\"customMeta\" data-dictid=\"afb15e4a331692777186e495b370a1\">diameter</span> &gt;13 mm confirms enlargement; &gt;16 mm indicates poor prognosis.</li>\n</ul>\n<p><strong>Haab’s Striae:</strong> Tears in Descemet's membrane, visible as <span class=\"customMeta\" data-dictid=\"1b8aa0db391692777194178f73c98c\">opaque</span> lines.</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Maxwell, Giorgina &amp; Souzeau, Emmanuelle.\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Ocular-signs-of-childhood-glaucoma-A-Megalocornea-and-corectopia-B-Haab-striae_fig2_383522893\" data-tags=\"\" height=\"339\" src=\"https://image.prepladder.com/content/TFDv5L2PYbzkwR9DABw31745318460.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p><strong>Additional Features:</strong></p>\n<ul>\n<li><strong>Thin Sclera:</strong> Appears blue due to underlying uveal tissue.</li>\n<li><strong>Deep <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">Anterior</span> Chamber:</strong> Indicates elevated IOP.</li>\n<li><strong>Iris Changes:</strong> Iridodonesis and atrophic patches in late stages.</li>\n<li><strong>Lens Changes:</strong> Becomes flat and may subluxate.</li>\n<li><strong>Optic Disc Changes:</strong> Variable <span class=\"customMeta\" data-dictid=\"4d57ccd00f1692777185c371df0426\">cupping</span> and atrophy.</li>\n<li><strong>Raised IOP:</strong> Elevated but not acute.</li>\n<li><strong>Axial Myopia:</strong> Due to increased <span class=\"customMeta\" data-dictid=\"01591f7f591692777182ef8aa2360c\">axial</span> length.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the best sign to indicate adequate growth in an infant with a birth weight of 2.8 kg?", "options": [{"label": "A", "text": "Increase in length of 25 cm in the first year", "correct": true}, {"label": "B", "text": "Weight gain of 300 grams per month till 1 year", "correct": false}, {"label": "C", "text": "Anterior fontanelle closure by 6 months of age", "correct": false}, {"label": "D", "text": "Weight under the 75th percentile and height under the 25th percentile", "correct": false}], "correct_answer": "A. Increase in length of 25 cm in the first year", "question_images": [], "explanation_images": [], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ Weight under the 75th percentile and height under the 25th percentile (Option D):</li></ul>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:400px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\"><strong>Age</strong></td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\"><strong>Length</strong></td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>At birth</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>50cm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>By 3 months</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>60cm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>By 9 months</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>70cm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>By 1 year<strong> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>75cm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>At 2 years</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>90cm</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>At 4-4.5 years</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>100cm</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>For &lt;1 year : </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>x + 9 ÷ 2 (</strong> Where x is age in months )</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>For 1-6 years : </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>2x + 8 (</strong> Where x is age in years )</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>For 7-12 years : </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>7x - 5 ÷ 2 (</strong> Where x is age in years )</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient came to medical OPD with complaints of polyuria. He has a history of undergoing total hypophysectomy. His Na+ levels were found to be 155 mEq/L, and his urine osmolarity was 200 mOsm/L. What is the definitive management in this patient?", "options": [{"label": "A", "text": "DDAVP for 2 weeks and then discontinue", "correct": false}, {"label": "B", "text": "DDAVP supplementation for lifelong", "correct": true}, {"label": "C", "text": "Upsetting of receptors, so no treatment required", "correct": false}, {"label": "D", "text": "Thiazides for 2 weeks", "correct": false}], "correct_answer": "B. DDAVP supplementation for lifelong", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the term used to describe the refractive error seen in the ocular examination image of a 60-year-old patient who has complained of reduced distant vision, but no longer requires spectacles for near vision?", "options": [{"label": "A", "text": "Index myopia", "correct": true}, {"label": "B", "text": "Axial myopia", "correct": false}, {"label": "C", "text": "Curvatural myopia", "correct": false}, {"label": "D", "text": "Positional myopia", "correct": false}], "correct_answer": "A. Index myopia", "question_images": ["https://image.prepladder.com/notes/YounuuPRtEW3O6L1j8my1745909938.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type of Myopia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cause</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Axial Myopia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increase in the <span class=\"customMeta\" data-dictid=\"c12a40cc401692777181852b507764\">anteroposterior</span> length of the <span class=\"customMeta\" data-dictid=\"53c6bebcbb169277718777b3fe0e5c\">eyeball</span> (most common form).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Curvatural Myopia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Increased <span class=\"customMeta\" data-dictid=\"4bd67d54f016927771850c953dadbc\">curvature</span> of the cornea, lens, or both.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Positional Myopia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Anterior placement of the <span class=\"customMeta\" data-dictid=\"35b1a3c6191692777185a1e2376fc0\">crystalline</span> lens in the eye.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Index Myopia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Increase in the <span class=\"customMeta\" data-dictid=\"cae831e44316927771973fa5e13fd7\">refractive</span> index of the <span class=\"customMeta\" data-dictid=\"35b1a3c6191692777185a1e2376fc0\">crystalline</span> lens, often due to nuclear sclerosis.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Myopia due to Excessive Accommodation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Caused by <span class=\"customMeta\" data-dictid=\"0338b655da16927771984b872baabb\">spasm</span> of accommodation, leading to excessive <span class=\"customMeta\" data-dictid=\"fefa53d9f216927772037e31a651d7\">focusing</span> power.</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical features </strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Asthenopic symptoms</li>\n<li>Half-shutting of eyes for better clarity</li>\n<li>Prominent eyeball.</li>\n<li>Prominent, large, and somewhat sluggishly reacting pupils.</li>\n<li>Slightly deeper <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> chamber.</li>\n<li>Normal fundus; rarely a <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> myopic <span class=\"customMeta\" data-dictid=\"0539eefe3f169277718547881d187d\">crescent</span> may be seen.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Prescription of appropriate <span class=\"customMeta\" data-dictid=\"9b5c0ed1601692777184e597f453c9\">concave</span> lenses</li>\n<li>Surgical Treatment</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 3-month-old baby comes with complaints of deafness, cataract, and patent ductus arteriosus. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Congenital herpes simplex virus infection", "correct": false}, {"label": "B", "text": "Congenital toxoplasmosis", "correct": false}, {"label": "C", "text": "Congenital cytomegalovirus infection", "correct": false}, {"label": "D", "text": "Congenital rubella syndrome", "correct": true}], "correct_answer": "D. Congenital rubella syndrome", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/torhGkMd0GTBdAUY2Oks1745319185.png", "https://image.prepladder.com/content/pGsj6C8JLjE4RRMixvES1745319189.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:900px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Congenital rubella</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Rubella (German measles) is a mild disease in infants and children but can cause <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> <span class=\"customMeta\" data-dictid=\"b8aa1ffb8916927771976438d71d1b\">rubella</span> syndrome (CRS) if contracted during pregnancy.</li>\n<li>The risk is highest in the first trimester, especially within the first 8 weeks.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathogenesis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Viremia is most intense from 10 to 17 days after infection.</li>\n<li>Viral shedding is from day 10 of infection up to 2 weeks.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Risk of Defects by Gestational Age</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Highest in the first 12 weeks of <span class=\"customMeta\" data-dictid=\"55b88ac71d169277718832be1a82c7\">gestation</span> and decreases significantly thereafter, with defects being rare after 20 weeks.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical features of <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> <span class=\"customMeta\" data-dictid=\"b8aa1ffb8916927771976438d71d1b\">rubella</span> syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Sensorineural <span class=\"customMeta\" data-dictid=\"f3f80e5bee1692777188f6eb1c4005\">hearing loss</span> (SNHL)</strong> (most common)</li>\n<li>Vision problems (<strong>cataracts</strong>, glaucoma, salt and pepper retinopathy).\n\t\t\t\t<ul>\n<li>Cataracts are the most common <span class=\"customMeta\" data-dictid=\"7b1f175723169277719459db16938e\">ocular</span> <span class=\"customMeta\" data-dictid=\"e7ed1a964716927771801ab913204a\">abnormality</span> associated with <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> rubella.</li>\n</ul>\n</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"Open Access\" data-source=\"File:Cataracts due to Congenital Rubella Syndrome (CRS) PHIL 4284 lores.jpg - Wikimedia Commons\" data-tags=\"\" height=\"206\" src=\"https://image.prepladder.com/content/torhGkMd0GTBdAUY2Oks1745319185.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<p>\\</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Jonathan Trobe\" data-hash=\"\" data-license=\"CC BY 3.0\" data-source=\"Congenital Rubella Syndrome, Salt and Pepper Retinopathy - Congenital rubella syndrome - Wikipedia\" data-tags=\"\" height=\"279\" src=\"https://image.prepladder.com/content/pGsj6C8JLjE4RRMixvES1745319189.png\" width=\"350\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n<ul>\n<li>Heart defects (<strong>patent <span class=\"customMeta\" data-dictid=\"7a6864e97b169277718602072817ee\">ductus</span> arteriosus</strong> &gt; <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"a66cd3adaa1692777182e77cb23021\">artery</span> <span class=\"customMeta\" data-dictid=\"0c9567c6cb16927771996c6bc2b21e\">stenosis</span> (right &gt; left) &gt; <span class=\"customMeta\" data-dictid=\"fc8cac43cc16927772015049bb5ab8\">ventricular</span> septal defect)</li>\n<li>Low birth weight</li>\n<li>Neurological issues (microcephaly, intellectual disabilities, encephalitis, behavioral issues)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Chronicity and Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Chronic presence of the virus can cause ongoing damage</li>\n<li>The risk of<strong> progressive <span class=\"customMeta\" data-dictid=\"b8aa1ffb8916927771976438d71d1b\">rubella</span> panencephalitis</strong> (PRP) years later is a rare complication.</li>\n<li>Less common complications: Growth retardation, hepatitis, bone lesions.</li>\n<li>Risk of diabetes and <span class=\"customMeta\" data-dictid=\"799202e6fe16927772009a1501b0a8\">thyroid</span> dysfunction</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Rubella IgM <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> <span class=\"customMeta\" data-dictid=\"9660c7ea2116927771894b30a0f80b\">immunosorbent</span> <span class=\"customMeta\" data-dictid=\"fc026ff6d81692777182835f6de6df\">assay</span> (detects antibodies)</li>\n<li>Viral isolation (growing the virus from samples)</li>\n<li>Polymerase chain reaction (PCR) (detects <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> RNA)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>No <span class=\"customMeta\" data-dictid=\"a4a589776216927771991b881f95b1\">specific treatment</span> for CRS; supportive care is key</li>\n<li>Early intervention for complications (e.g., hearing loss) is crucial</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prevention</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Standard with <span class=\"customMeta\" data-dictid=\"33843a1c3716927771867f807275d2\">droplet</span> <span class=\"customMeta\" data-dictid=\"43ce88387a1692777196387ed2c267\">precaution</span> in hospitalized cases</li>\n<li>Rubella <span class=\"customMeta\" data-dictid=\"f23be6aa561692777201ca2e1aaa27\">vaccination</span> <strong>RA 27/3 live attenuated vaccine</strong> (MMR or MMRV with varicella) effectively prevents <span class=\"customMeta\" data-dictid=\"b8aa1ffb8916927771976438d71d1b\">rubella</span> and CRS</li>\n<li>MMR vaccine has a 95% <span class=\"customMeta\" data-dictid=\"7f80be61231692777187391e91e867\">efficacy</span> after one dose and 99% after two doses</li>\n<li>Vaccination side effects: fever, rash, joint pain</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Considerations for Pregnant Women</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Immunoglobulin may be considered if pregnancy is not terminated, though it does not guarantee prevention of <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> infection</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 65-year-old chronic smoker came to the medicine outpatient department with complaints of upper chest discomfort and drooping of an eyelid. He also complained of pain radiating to the upper arm and a tingling sensation in the 4th and 5th digits of his right hand. The chest X-ray is given below. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Pancoast tumor", "correct": true}, {"label": "B", "text": "Superior vena cava obstruction", "correct": false}, {"label": "C", "text": "Upper lobe pneumonia", "correct": false}, {"label": "D", "text": "Aspergilloma", "correct": false}], "correct_answer": "A. Pancoast tumor", "question_images": ["https://image.prepladder.com/notes/EVxUnxu11NqJHF0t4zuf1745918070.png"], "explanation_images": ["https://image.prepladder.com/notes/EVxUnxu11NqJHF0t4zuf1745918070.png", "https://image.prepladder.com/notes/2dkdau5sNewHh4BOnQXh1745918070.png", "https://image.prepladder.com/notes/EBlrYnc3hk8YG58uuw7c1745918071.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Chloride level in sweat is used in the diagnosis of which disease:", "options": [{"label": "A", "text": "Phenylketonuria", "correct": false}, {"label": "B", "text": "Cystic fibrosis", "correct": true}, {"label": "C", "text": "Gaucher’s disease", "correct": false}, {"label": "D", "text": "Osteogenesis imperfecta", "correct": false}], "correct_answer": "B. Cystic fibrosis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child presents with fever and a rash spreading from the face, behind cheeks and buccal mucosa to other body parts. On examination, Koplik's spot is present. What is the likely diagnosis?", "options": [{"label": "A", "text": "Measles", "correct": true}, {"label": "B", "text": "Rubella", "correct": false}, {"label": "C", "text": "Varicella", "correct": false}, {"label": "D", "text": "Mumps", "correct": false}], "correct_answer": "A. Measles", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/YtzN85tsQq28BAVPImG21745319592.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:800px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Aspects </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causative agent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Measles (rubeola) is a highly <span class=\"customMeta\" data-dictid=\"6f6ef8bf7c1692777184dfdf8cf45d\">communicable</span> childhood <span class=\"customMeta\" data-dictid=\"4f279b047716927771872685599ba9\">exanthematous</span> illness caused by the <span class=\"customMeta\" data-dictid=\"7d2dc6a6df1692777192ccc6fd72b7\">measles</span> virus, an RNA virus from the Paramyxoviridae family.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Transmission</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Contact with <span class=\"customMeta\" data-dictid=\"33843a1c3716927771867f807275d2\">droplet</span> aerosols (through the <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> or conjunctiva)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathogenesis </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Primary viremia</strong> occurs, resulting in infection of the <span class=\"customMeta\" data-dictid=\"77c058b3b21692777197f5fd539d12\">reticuloendothelial</span> system, followed by<strong> secondary viremia,</strong> which results in <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> symptoms.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Incubation period</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>8-12 days</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Period of infectivity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>From 3 days before to 4 days after the <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> onset</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Common in preschool children</li>\n<li><strong>Prodromal phase: </strong>Fever (before rash), rhinorrhea, conjunctival <span class=\"customMeta\" data-dictid=\"2dd9736fdf16927771849f5a925f7d\">congestion</span> and a dry hacking cough.</li>\n<li><strong>Koplik spots</strong>, <span class=\"customMeta\" data-dictid=\"0e147ef62e1692777194c4761f6194\">pathognomonic</span> for measles, appear on the <strong>2nd or 3rd day of illness</strong> as grey-white, sand-like lesions with surrounding <span class=\"customMeta\" data-dictid=\"f0f3e105661692777187df507b1f26\">erythema</span> on the <span class=\"customMeta\" data-dictid=\"d72626dd5c1692777183f1c92b2deb\">buccal</span> <span class=\"customMeta\" data-dictid=\"31ae8f4dc51692777193069d92be37\">mucosa</span> opposite the lower second molars.</li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"CDC\" data-hash=\"\" data-license=\"Open access\" data-source=\"https://en.wikipedia.org/wiki/Koplik%27s_spots#/media/File:Koplik_spots,_measles_6111_lores.jpg\" data-tags=\"\" height=\"417\" src=\"https://image.prepladder.com/content/YtzN85tsQq28BAVPImG21745319592.png\" width=\"400\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Rash</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The erythematous <span class=\"customMeta\" data-dictid=\"a4fdae630a16927771918eaa32d28b\">maculopapular</span> <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> in <span class=\"customMeta\" data-dictid=\"7d2dc6a6df1692777192ccc6fd72b7\">measles</span> <strong>appears on the 4th day, starting behind the ears, along the hairline, and <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> cheeks</strong>, then <strong>spreading to the rest of the body over the next 2-3 days.</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Symptomatic and conservative (antipyretics, maintenance of hygiene, ensuring adequate fluid and <span class=\"customMeta\" data-dictid=\"39156a37b21692777183372a301aa8\">caloric</span> intake, and humidification).</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 3-week-old infant presents with a cough and sore throat. The mother reports that the infant develops a paroxysm of cough followed by apnea. The total leukocyte count is &amp;gt;50,000 cells/μL. Which of the following drugs will you prescribe for this patient?", "options": [{"label": "A", "text": "Azithromycin", "correct": true}, {"label": "B", "text": "Amoxicillin", "correct": false}, {"label": "C", "text": "Cotrimoxazole", "correct": false}, {"label": "D", "text": "Clarithromycin", "correct": false}], "correct_answer": "A. Azithromycin", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Pertussis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causative agent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Bordetella pertussis, <span class=\"customMeta\" data-dictid=\"69e1e04b2d16927771837675e4a49f\">Bordetella</span> parapertussis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Secondary attack rate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>100%</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Clinical Stages</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ol>\n<li><strong>Catarrhal </strong>(1-2 weeks): Cold-like symptoms, worsening cough</li>\n<li><strong>Paroxysmal </strong>(2-6 weeks): Severe cough, \"whoop\", vomiting</li>\n<li><strong>Convalescent </strong>(1-4 weeks): Recovery</li>\n</ol>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Apnea, <span class=\"customMeta\" data-dictid=\"b913f965781692777194c867946afe\">Otitis</span> media, Pneumonia, <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> hypertension, <span class=\"customMeta\" data-dictid=\"25ec593008169277718360336a849a\">Cardiogenic</span> shock, Hemorrhage, Seizures, <span class=\"customMeta\" data-dictid=\"9cf1b2a8bc16927771899480554f5a\">hernia</span> and malnutrition.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clinical signs, <span class=\"customMeta\" data-dictid=\"790f98dd571692777193fd47da1230\">nasopharyngeal</span> <span class=\"customMeta\" data-dictid=\"b76c34e672169277719964ab6c1b56\">swab</span> culture, PCR, serology.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Differential Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Adenoviral infection, TB, foreign body inhalation, <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> compression.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>First-line antibiotics for treating pertussis:</strong></p>\n<ul>\n<li><strong>Azithromycin</strong> is the first-line treatment for <span class=\"customMeta\" data-dictid=\"e407b4ecb9169277719549831239bb\">pertussis</span> in all age groups.</li>\n<li><strong>Erythromycin and <span class=\"customMeta\" data-dictid=\"00c4a4fe9b1692777184136ffde6c9\">clarithromycin</span> </strong>are alternative treatments but are <strong>C/I in &lt;1 month old </strong>due to risk for <span class=\"customMeta\" data-dictid=\"4c815174781692777190e1b4a5d704\">infantile</span> <span class=\"customMeta\" data-dictid=\"2cf4f27ae616927771895f410747ad\">hypertrophic pyloric stenosis</span> <strong>(IHPS). (Option D)</strong></li>\n</ul>\n<p><strong>Alternative antibiotics:</strong> For patients<strong> allergic to macrolides</strong> or there is unavailability of azithromycin,<strong> trimethoprim-sulfamethoxazole (cotrimoxazole)</strong> may be used, but it is <strong>C/I in &lt;2 months</strong> <strong>old </strong>(due to the risk for <strong>kernicterus</strong>) <strong>(Option C)</strong></p>\n<p><strong>Timing of treatment: </strong>Antibiotics are most effective during the <strong>catarrhal stage</strong></p>\n<p><strong>Isolation: </strong>Patients diagnosed with <span class=\"customMeta\" data-dictid=\"e407b4ecb9169277719549831239bb\">pertussis</span> should be isolated from others, especially vulnerable populations like infants and the elderly, for at least <strong>5 days after starting antibiotics</strong>.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Prevention</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>DTaP vaccine (Diphtheria, Tetanus, and Pertussis):</strong> Given to children under 7 years of age as part of routine childhood vaccinations.</p>\n<p> </p>\n<p><strong>Tdap vaccine (Tetanus, Diphtheria, and Pertussis): </strong>Recommended for adolescents, adults, and pregnant women (preferably between 27 and 36 weeks gestation) to provide protection and reduce transmission to infants.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child is brought to the hospital with respiratory distress and biphasic stridor. The radiograph is shown below. What is the diagnosis?", "options": [{"label": "A", "text": "Acute epiglottitis", "correct": false}, {"label": "B", "text": "Acute laryngotracheobronchitis", "correct": true}, {"label": "C", "text": "Foreign body aspiration", "correct": false}, {"label": "D", "text": "Laryngomalacia", "correct": false}], "correct_answer": "B. Acute laryngotracheobronchitis", "question_images": ["https://image.prepladder.com/content/nLBYdNbfA6DMlwsu31lO1745319827.png"], "explanation_images": ["https://image.prepladder.com/content/JHkRr7hk1Hc2ngiu266x1745319910.png", "https://image.prepladder.com/content/zrSL3s9kuqvR6liizp5u1745319923.png", "https://image.prepladder.com/notes/xZNMjL0VvWp2DwX9WPHE1745912606.png", "https://image.prepladder.com/content/rBBMoMcqqr9fMWDljrTj1745319947.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:800px\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Laryngotracheobronchitis (Croup):</strong></p>\n<p>Refers to <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> infection of the glottic and <span class=\"customMeta\" data-dictid=\"b83a5450d216927771990efacefc4c\">subglottic</span> regions.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Causative Agent</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Parainfluenza viruses (types 1,2 and 3) cause about 75% cases.</li>\n<li>Other Viruses:\n\t\t\t\t<ul>\n<li>Influenza A and B</li>\n<li>Adenovirus</li>\n<li>Respiratory syncytial virus</li>\n<li>Measles</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Age Group</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Most common in children aged 3 months to 5 years.</li>\n<li>Peak <span class=\"customMeta\" data-dictid=\"17cd3771bb1692777190950c142dbe\">incidence</span> occurs in the 2nd year of life.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Initial Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>These symptoms last 1-3 days before development of upper <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> signs and symptoms.</p>\n<ul>\n<li>Upper <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> infection</li>\n<li>Rhinorrhea</li>\n<li>Pharyngitis</li>\n<li>Mild cough</li>\n<li>Low-grade fever</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Progressive Symptoms </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Barking cough</strong></li>\n<li>Hoarseness</li>\n<li><strong>Inspiratory stridor</strong></li>\n<li>Fever may reach 39-40°C (102.2-104°F) or be absent.</li>\n<li>Child <strong>prefers to sit up</strong> in bed or be<strong> held upright. </strong></li>\n<li>Symptoms worsen at night, recur over days and resolve within a week.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Physical Examination Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hoarse voice</li>\n<li>Coryza</li>\n<li>Normal to moderately inflamed pharynx.</li>\n<li>Slightly increased <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> rate.</li>\n<li><strong>Hypoxia and low oxygen saturation</strong> (seen only in complete <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> obstruction).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis </strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Clinical diagnosis</li>\n<li>X-ray PA view of neck: <strong>Steeple sign, </strong>which is characteristic of <strong>subglottic narrowing</strong></li>\n</ul>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Frank Gaillard,\" data-hash=\"\" data-license=\"CC BY SA 3.0\" data-source=\"https://en.wikipedia.org/wiki/Steeple_sign#/media/File:Croup_steeple_sign.jpg\" data-tags=\"\" height=\"243\" src=\"https://image.prepladder.com/content/JHkRr7hk1Hc2ngiu266x1745319910.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Mainstay of Treatment:</strong> Focus on <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> management and <span class=\"customMeta\" data-dictid=\"a249eeb5551692777189661d39c1b2\">hypoxia</span> treatment.</li>\n<li><strong>Mild croup: </strong>Single dose dexamethasone.</li>\n<li><strong>Moderate to severe croup: </strong>Nebulized <span class=\"customMeta\" data-dictid=\"76baf6616a169277718738f8790ab9\">epinephrine</span> in addition to dexamethasone.</li>\n<li><strong>Nebulized Racemic Epinephrine: </strong>Used for moderate to severe <span class=\"customMeta\" data-dictid=\"c8af142f48169277719965c593fa0b\">stridor</span> at rest, possible need for intubation, <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"afafb9026e1692777186e3dd168fa8\">distress</span> and hypoxia.</li>\n<li><strong>Corticosteroids:</strong>\n<ul>\n<li>Decrease <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> in laryngeal mucosa</li>\n<li>Oral steroids beneficial in mild croup</li>\n<li>Dexamethasone 0.6 mg/kg single dose; as low as 0.15 mg/kg may be effective.</li>\n</ul>\n</li>\n</ul>\n<ul>\n<li>Antibiotics are not indicated.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 3-month-old baby presents with jaundice and clay-colored stools. Lab investigation reveals that the baby has conjugated hyperbilirubinemia. The liver biopsy shows periductal proliferation. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Crigler-Najjar syndrome", "correct": false}, {"label": "B", "text": "Rotor syndrome", "correct": false}, {"label": "C", "text": "Dubin-Johnson syndrome", "correct": false}, {"label": "D", "text": "Biliary atresia", "correct": true}], "correct_answer": "D. Biliary atresia", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is false regarding the given image?", "options": [{"label": "A", "text": "It represents melanocytic hamartoma", "correct": false}, {"label": "B", "text": "It causes no visual disturbance", "correct": false}, {"label": "C", "text": "It is associated with facial angiofibroma", "correct": true}, {"label": "D", "text": "They are diagnostic of a neurocutaneous syndrome", "correct": false}], "correct_answer": "C. It is associated with facial angiofibroma", "question_images": ["https://image.prepladder.com/notes/0KAYPBFWc32ETBdHQlzq1745913127.jpg"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:581px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Feature</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Café-au-lait macules (CALMs)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>&gt;5 mm in prepubertal, &gt;15 mm in postpubertal.</p>\n<p><strong>6 or more</strong> needed for diagnosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Axillary/Inguinal Freckling</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Multiple hyperpigmented areas, 2-3 mm in diameter.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Iris Lisch Nodules (Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Hamartomas in the <span class=\"customMeta\" data-dictid=\"6e53fc929616927771900fbab3617f\">iris</span> (Option A)</strong>, best seen with a slit-lamp.</p>\n<p>2 or more needed for diagnosis and <strong>doesn’t cause any visual disturbances. (Option B)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Neurofibromas</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Two or more neurofibromas or one <span class=\"customMeta\" data-dictid=\"946db798c6169277719544d7b31041\">plexiform</span> neurofibroma.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Osseous Lesion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Sphenoid <span class=\"customMeta\" data-dictid=\"984733db481692777186757cce6e6b\">dysplasia</span> (which may cause pulsating exophthalmos) or <span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\">cortical</span> thinning of long bones with or without <span class=\"customMeta\" data-dictid=\"62a73dfd591692777196c0884c3f76\">pseudoarthrosis</span> (most often the tibia).</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Optic Gliomas</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>CNS tumor affecting the <span class=\"customMeta\" data-dictid=\"1b9a354cdb1692777194802683234d\">optic</span> nerve.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Family History</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>First-degree relative with an NF1 diagnosis based on these criteria.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient hailing from Delhi presents with high fever, arthralgia, retrobulbar pain, and extensive petechial rash for 3 days. Lab investigations reveal: Hemoglobin: 9 g/dL WBC count: 9000 cells/mm³ Platelet count: 20,000 cells/mm³ Positive tourniquet test What is the most likely diagnosis?", "options": [{"label": "A", "text": "Dengue fever", "correct": false}, {"label": "B", "text": "Dengue hemorrhagic fever", "correct": true}, {"label": "C", "text": "Dengue shock syndrome", "correct": false}, {"label": "D", "text": "Malaria", "correct": false}], "correct_answer": "B. Dengue hemorrhagic fever", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Neurological</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Dengue encephalopathy</strong> is <strong>most commonly encountered neurological complication</strong> of <span class=\"customMeta\" data-dictid=\"75dc439beb16927771857bde5104df\">dengue</span> virus\n\t\t\t\t<ul>\n<li>Linked primarily to <span class=\"customMeta\" data-dictid=\"75dc439beb16927771857bde5104df\">dengue</span> hemorrhagic fever and <span class=\"customMeta\" data-dictid=\"75dc439beb16927771857bde5104df\">dengue</span> shock syndrome</li>\n<li>EEG may show abnormalities such as burst <span class=\"customMeta\" data-dictid=\"7b7c55fbdd16927771990b50bda606\">suppression</span> and seizures</li>\n<li>CSF profiles typically remain normal.</li>\n<li>Neuroimaging can be normal or reveal <span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\">diffuse</span> cerebral edema.</li>\n</ul>\n</li>\n<li><strong>Encephalitis</strong></li>\n<li><strong>GBS</strong></li>\n<li><strong>Stroke</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Cardiomyopathy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Dengue virus-induced dilated <span class=\"customMeta\" data-dictid=\"6e6dd7aed216927771831ebdf9703c\">cardiomyopathy</span> should always be considered if a <span class=\"customMeta\" data-dictid=\"75dc439beb16927771857bde5104df\">dengue</span> fever patient has <span class=\"customMeta\" data-dictid=\"3790c638ab16927771970a0a41d3ab\">refractory</span> shock and signs and symptoms of congestive heart failure.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hepatic injury</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Liver involvement in <span class=\"customMeta\" data-dictid=\"75dc439beb16927771857bde5104df\">dengue</span> is a crucial feature</li>\n<li>The effect ranges from an <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> rise in liver enzymes to the development of ALF</li>\n<li>The <strong>most common <span class=\"customMeta\" data-dictid=\"06123ff61a1692777182e19b790ebc\">atypical</span> manifestation</strong> reported was hepatitis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pneumonia</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Staphylococcus <span class=\"customMeta\" data-dictid=\"1000989d33169277719652247cd559\">pneumonia</span> is an important accompanying problem seen in <span class=\"customMeta\" data-dictid=\"75dc439beb16927771857bde5104df\">dengue</span> patient</li>\n<li>Co-infection between <span class=\"customMeta\" data-dictid=\"75dc439beb16927771857bde5104df\">dengue</span> and <span class=\"customMeta\" data-dictid=\"c3817918b816927771902d2176d0c8\">influenza</span> can result in <span class=\"customMeta\" data-dictid=\"b5a5dcf4021692777187e3c0d2d47d\">exacerbation</span> of pneumonia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Orchitis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Orchitis usually occurs together with epididymitis</li>\n<li>Commonly seen in <span class=\"customMeta\" data-dictid=\"e48bb8abfa1692777192e3fa06774f\">men</span> between 14 and 35 years of age.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dengue Hemorrhagic Fever</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>All of the following:</p>\n<ul>\n<li>Acute onset of fever</li>\n<li>2-7 days duration</li>\n<li>Hemorrhagic manifestations\n\t\t\t\t<ul>\n<li>Positive <span class=\"customMeta\" data-dictid=\"337361b1601692777200049d28078e\">tourniquet</span> test/Petechiae</li>\n<li>Ecchymosis</li>\n<li>Purpura/Bleeding from mucosa, GIT, <span class=\"customMeta\" data-dictid=\"3509997646169277719014053aa74d\">Injection</span> sites, etc</li>\n</ul>\n</li>\n<li>Platelet count ≤ 100,000 cells/cu.mm.</li>\n<li>Plasma leakage\n\t\t\t\t<ul>\n<li>Rising hematocrit\n\t\t\t\t\t<ul>\n<li>Hemoconcentration &gt;20%</li>\n</ul>\n</li>\n<li>Pleural effusion, ascites/Hypoproteinemia)</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dengue Shock Syndrome</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>DHF criteria plus Signs of Shock</li>\n<li>Tachycardia/Cool extremities/Weak pulse/Lethargy/Restlessness</li>\n<li>Pulse pressure &lt;20 <span class=\"customMeta\" data-dictid=\"66ae2626ae169277719278edf9936d\">mm Hg</span> with increased <span class=\"customMeta\" data-dictid=\"a44fd2b1e71692777186a33144c6ad\">Diastolic pressure</span> (e.g. 100/80)</li>\n<li>Hypotension (Systolic &lt;80 <span class=\"customMeta\" data-dictid=\"66ae2626ae169277719278edf9936d\">mm Hg</span> for age &lt;5 years/80-90 <span class=\"customMeta\" data-dictid=\"66ae2626ae169277719278edf9936d\">mm Hg</span> for older children and adults)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 54-year-old woman was diagnosed with advanced cervical cancer. She has a 14-year-old daughter. What advice would you give her?", "options": [{"label": "A", "text": "Screen for BRCA mutation", "correct": false}, {"label": "B", "text": "Advise HPV vaccine", "correct": true}, {"label": "C", "text": "Screen for PTEN mutation", "correct": false}, {"label": "D", "text": "Perform cervical biopsy", "correct": false}], "correct_answer": "B. Advise HPV vaccine", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is true about Trichomonas vaginalis?", "options": [{"label": "A", "text": "Trophozoite has 2 nuclei", "correct": false}, {"label": "B", "text": "Twitching motility is seen on wet saline mount", "correct": true}, {"label": "C", "text": "Cysts are seen on wet saline mount of vaginal secretions", "correct": false}, {"label": "D", "text": "Infective form is cyst", "correct": false}], "correct_answer": "B. Twitching motility is seen on wet saline mount", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/5actSvkPazTt7gqNW70n1745321605.png", "https://image.prepladder.com/content/XVXMSBX7uzmaakVLgPjC1745321731.png", "https://image.prepladder.com/content/5KLheGxRswSGfEYvEEXF1745321747.png", "https://image.prepladder.com/notes/37G5pZPO3ZnBQy6pBFRs1746800851.png", "https://image.prepladder.com/content/hnmRMWZIVXsg62i4wiw81745321783.png", "https://image.prepladder.com/content/GeCYh4VGuz4FVZxjC8OP1745321795.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p style=\"text-align:center\"><strong>Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p style=\"text-align:center\"><strong>Bacterial Vaginosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p style=\"text-align:center\"><strong>Trichomoniasis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:bottom\">\n<p style=\"text-align:center\"><strong>Candidiasis (Yeast Infection)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Discharge</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Thin, greyish-white, <span class=\"customMeta\" data-dictid=\"0780d98cec1692777189247c5a9456\">homogenous</span> discharge</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Frothy, yellow-green, often malodorous discharge</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Thick, white, cottage cheese-like discharge, often odourless</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Odor</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Fishy odour, particularly noticeable after intercourse</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>A foul odour can be strong and unpleasant</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Usually no significant odor</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Genital Itching/Irritation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>May or may not be present</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Common</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Common, along with redness and <span class=\"customMeta\" data-dictid=\"e3d212ebd316927771996e0c472d4a\">swelling</span> of the vulva</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>pH of <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">Vaginal</span> Discharge</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Elevated (usually above 4.5)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Elevated (usually above 4.5)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Normal <span class=\"customMeta\" data-dictid=\"9a1e50b8221692777201b95b66c9de\">vaginal</span> pH (4.0 to 4.5)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Microscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Clue Cells </strong>(epithelial cells with adherent bacteria)</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Mikael Häggström,\" data-hash=\"\" data-license=\"CC0 1.0\" data-source=\"https://en.wikipedia.org/wiki/Clue_cell#/media/File:Micrograph_of_a_clue_cell,_annotated.jpg\" data-tags=\"\" height=\"158\" src=\"https://image.prepladder.com/content/XVXMSBX7uzmaakVLgPjC1745321731.png\" width=\"209\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Motile, pear-shaped, <span class=\"customMeta\" data-dictid=\"9878bc208e169277720243c5c74543\">flagellated</span> organisms</p>\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"na\" data-hash=\"\" data-license=\"Open Access\" data-source=\"CC0 1.0\" data-tags=\"\" height=\"194\" src=\"https://image.prepladder.com/content/5KLheGxRswSGfEYvEEXF1745321747.png\" width=\"198\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Hyphae and buds, spores</p>\n<figure class=\"caption_element\"><img alt=\"Candida albicans- Microscopy\" data-author=\"Engberts, Maria Karin, Hans Korporaal, Maurits Vinkers, Alex van Belkum, Jaap van Binsbergen, Toine Lagro-Janssen, Theo Helmerhorst, and Wim van der Meijden\" data-hash=\"12461\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/Chapter-4-Candida-vaginalis-in-a-Papanicolaou-stained-smear_fig7_5387779\" data-tags=\"May2025\" height=\"159\" src=\"https://image.prepladder.com/notes/37G5pZPO3ZnBQy6pBFRs1746800851.png\" width=\"200\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Microscopic Pathogen</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Overgrowth of <span class=\"customMeta\" data-dictid=\"4880fc99551692777181e25a64560f\">anaerobic</span> bacteria (Gardnerella vaginalis)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Protozoan <span class=\"customMeta\" data-dictid=\"a59b97ce831692777194f6c0160f15\">parasite</span> (Trichomonas vaginalis)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Overgrowth of Candida species (Candida <span class=\"customMeta\" data-dictid=\"ec6a29c167169277718195e3b531cf\">albicans</span> most common)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Tab Secnidazole 2g stat</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Tab Secnidazole 2g stat</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<p>Tab Fluconazole 150 mg OD <span class=\"customMeta\" data-dictid=\"6e9cbd73891692777198a373ec041f\">stat</span> (Itraconazole 600 mg - alternative)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<figure class=\"caption_element\"><img alt=\"\" data-author=\"Bicha, Mequanint &amp; Arefeayinie, Ayalew\" data-hash=\"\" data-license=\"Open Access\" data-source=\"https://www.researchgate.net/figure/Magnified-image-of-the-strawberry-cervix_fig2_372430588\" data-tags=\"\" height=\"182\" src=\"https://image.prepladder.com/content/hnmRMWZIVXsg62i4wiw81745321783.png\" width=\"198\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:middle\">\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Tarsh Bates\" data-hash=\"\" data-license=\"NA\" data-source=\"https://www.researchgate.net/figure/Candda-albicans-infection-of-human-cervix-http-philcdcgov-phil-detailsasp-This_fig3_313750917\" data-tags=\"\" height=\"205\" src=\"https://image.prepladder.com/content/GeCYh4VGuz4FVZxjC8OP1745321795.png\" width=\"260\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old female patient presents with a foul-smelling bloody discharge mixed with mucous from the vagina, upon examination, exhibits a necrotizing growth in the cervix with lateral parametrium involvement. What is the management for this patient?", "options": [{"label": "A", "text": "Chemotherapy", "correct": false}, {"label": "B", "text": "Brachytherapy", "correct": false}, {"label": "C", "text": "Chemoradiation", "correct": true}, {"label": "D", "text": "Surgery", "correct": false}], "correct_answer": "C. Chemoradiation", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Surgical Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Post-Surgical Management</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>IA1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Simple <span class=\"customMeta\" data-dictid=\"633cf90e4016927771891fa018663e\">hysterectomy</span> (Type I).</li>\n<li>Conization if family not complete</li>\n</ul>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p> </p>\n<p> </p>\n<p>Regular <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> exams and <span class=\"customMeta\" data-dictid=\"db0c1e31b81692777194c625af6798\">Pap</span> smears.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>IA1 (with LVSI)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Modified radical <span class=\"customMeta\" data-dictid=\"633cf90e4016927771891fa018663e\">hysterectomy</span> (Type II) + <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> <span class=\"customMeta\" data-dictid=\"27896a100c169277719111d4c4f539\">lymphadenectomy</span> (PLND).</li>\n<li>Radical <span class=\"customMeta\" data-dictid=\"bfdf455449169277720023fbcbb064\">trachelectomy</span> + PLND (consider SNLB) for selected patients desiring fertility</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>IA2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Radical <span class=\"customMeta\" data-dictid=\"633cf90e4016927771891fa018663e\">hysterectomy</span> + PLND (consider SNLB if tumour &lt;2 cm).</li>\n<li>Radical <span class=\"customMeta\" data-dictid=\"bfdf455449169277720023fbcbb064\">trachelectomy</span> + PLND for selected patients desiring fertility.</li>\n</ul>\n</td>\n<td rowspan=\"4\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p> </p>\n<p> </p>\n<ul>\n<li>If the <span class=\"customMeta\" data-dictid=\"c02ad9ae0f1692777198d76afc93c4\">specimen</span> shows high-risk features - <span class=\"customMeta\" data-dictid=\"1a38e9a3321692777180b2468ff799\">Adjuvant</span> chemoradiation.</li>\n<li>Regular <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> exams and <span class=\"customMeta\" data-dictid=\"db0c1e31b81692777194c625af6798\">Pap</span> smears.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>IB1</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Radical <span class=\"customMeta\" data-dictid=\"633cf90e4016927771891fa018663e\">hysterectomy</span> + PLND (consider SNLB if tumour &lt;2 cm).</li>\n<li><strong>Radical <span class=\"customMeta\" data-dictid=\"bfdf455449169277720023fbcbb064\">trachelectomy</span> + PLND for selected patients desiring fertility.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>IB2</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Radical <span class=\"customMeta\" data-dictid=\"633cf90e4016927771891fa018663e\">hysterectomy</span> + PLND</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>IIA1</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>IB3 - IIA2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Chemoradiation</p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p> </p>\n<p>Regular <span class=\"customMeta\" data-dictid=\"7cd6eb19341692777195d83aafdcb3\">pelvic</span> exams and <span class=\"customMeta\" data-dictid=\"db0c1e31b81692777194c625af6798\">Pap</span> smears</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>IIB - IVA</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Chemoradiation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>IVB</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Palliative <span class=\"customMeta\" data-dictid=\"8602c4b260169277718439bb122cb0\">chemotherapy</span> and/or <span class=\"customMeta\" data-dictid=\"8a0b36beb6169277719466e16c52d7\">Palliative</span> radiotherapy</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 28-year-old woman with a history of multiple sexual partners presents with lower abdominal pain for 1 month. She experiences minimal discharge and complaints of inter-menstrual bleeding. What is the most likely cause?", "options": [{"label": "A", "text": "Neisseria gonorrhoea", "correct": true}, {"label": "B", "text": "Genital TB", "correct": false}, {"label": "C", "text": "Candida", "correct": false}, {"label": "D", "text": "Herpes simplex", "correct": false}], "correct_answer": "A. Neisseria gonorrhoea", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "According to the Colombo plan, which of the following statements regarding cancer treatment is correct?", "options": [{"label": "A", "text": "Help with PET scan units for diagnosis of cancer", "correct": false}, {"label": "B", "text": "Human resource strengthening", "correct": false}, {"label": "C", "text": "Setting up chemotherapy units", "correct": false}, {"label": "D", "text": "Setting up cobalt therapy units", "correct": true}], "correct_answer": "D. Setting up cobalt therapy units", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Hkgfpqx4d5ID9w5zqKsi1745322564.png"], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse; width:1000px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>The Colombo Plan</strong></p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"NA\" data-source=\"NA\" data-tags=\"\" height=\"369\" src=\"https://image.prepladder.com/content/Hkgfpqx4d5ID9w5zqKsi1745322564.png\" width=\"378\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Multilateral agency.</li>\n<li>Promotes the concept of collective intergovernmental for economic and social development in South and Southeast Asia.</li>\n<li>Primary focus is on agricultural and industrial development and sometimes on health.</li>\n<li>Membership - 20 developing countries.</li>\n<li>6 non-regional members - Australia, Canada, Japan, New Zealand, UK, USA.</li>\n<li><strong>Provides <span class=\"customMeta\" data-dictid=\"e3555f448716927771844820d69cfa\">Cobalt</span> Radiotherapy Units to Medical Colleges</strong></li>\n<li>AIIMS in New Delhi was established with financial assistance from New Zealand.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A lady from West Rajasthan presented with an ulcer surrounded by erythema on the right leg. Microscopy of the biopsy from the edge of the ulcer showed organisms with dark staining nuclei and kinetoplast. What is the most likely causative agent?", "options": [{"label": "A", "text": "Leishmania tropica", "correct": true}, {"label": "B", "text": "Babesia", "correct": false}, {"label": "C", "text": "Trypanosoma cruzi", "correct": false}, {"label": "D", "text": "Histoplasma", "correct": false}], "correct_answer": "A. Leishmania tropica", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/CMxiRTjwQmsY2S8NbqTl1745322178.png", "https://image.prepladder.com/content/MBGfh4DRfKGSjdHBmn9e1745322219.png", "https://image.prepladder.com/content/1beSYGizSmfZC8TOkLAT1745322243.png", "https://image.prepladder.com/content/CvzOzA94NVlDr62jNqGQ1745322269.png", "https://image.prepladder.com/content/29coAK6hLPfmaBlEp1011745322527.png"], "explanation": "\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Kala-azar/ Black sickness/Dum-dum fever/Sandfly disease/ Visceral Leishmaniasis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Organism</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Protozoan</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Epidemiology</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Endemic in Uttar Pradesh, Bihar, Jharkhand, West Bengal</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Types</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Visceral (Kala-Azar)</strong>: L. donovani</li>\n<li><strong>Cutaneous</strong>: L. tropica</li>\n<li><strong>Mucocutaneous</strong>: L. braziliensis</li>\n<li>Post-kala-azar <span class=\"customMeta\" data-dictid=\"532334711316927771865e5309b763\">dermal</span> (<strong>PKLD</strong>): Immune response</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reservoir</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Humans (non-zoonotic)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Vector</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Sandfly (Phlebotomus argentipes): has <span class=\"customMeta\" data-dictid=\"a4789768d21692777188e77f1969cd\">hairy</span> wings.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Environmental</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Peak outbreak: November to April</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mechanism of transmission</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Bite of sandfly</li>\n<li>Blood <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">transfusion</span> (rare)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Incubation period</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>10 days to 2 years. (1-4 months average)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clinical features</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Visceral: Fever, Weight loss, Hepatosplenomegaly, Anemia.</li>\n<li>Cutaneous: Painful skin ulcers</li>\n<li>Mucocutaneous: Rapid mucosal destruction of nose and oropharynx</li>\n<li>PKDL: Skin nodules filled with micro-organisms</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diagnosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Rapid <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">diagnostic</span> kits: <strong>rk39-dipstick test</strong>.\n\t\t\t\t<ul>\n<li>Used for field surveys.</li>\n</ul>\n</li>\n<li><strong>Biopsy (Gold standard)</strong>: Leishmania Donovan bodies</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sandfly control measures</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>DDT: 1-2gm/m<sup>2</sup>.</li>\n<li>BHC (benzene hexachloride)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Treatment</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>DOC: Single dose Liposomal amphotericin-B (LAMB)10 mg/kg</strong></li>\n<li>Alternatives:\n\t\t\t\t<ul>\n<li>Miltefosine + Paramomycin</li>\n<li>Pentamidine</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A poor farmer with a history of successive crop failure develops progressive spastic paraparesis, signs of upper motor neuron paralysis, and gait instability. Name the toxin responsible for this condition.", "options": [{"label": "A", "text": "Aflatoxin", "correct": false}, {"label": "B", "text": "Beta-oxalyl-amino-alanine", "correct": true}, {"label": "C", "text": "Ergot alkaloids", "correct": false}, {"label": "D", "text": "Fusarium toxin", "correct": false}], "correct_answer": "B. Beta-oxalyl-amino-alanine", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/zWggTQKJiEPkuy2vmDjL1745322634.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Causative agent</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<ul>\n<li>Beta-oxalyl <span class=\"customMeta\" data-dictid=\"543f207eb51692777181723491a358\">amino</span> <span class=\"customMeta\" data-dictid=\"7f4e6edbc91692777181c6fa295ae7\">alanine</span> (BOAA) present in Lathyrus sativus</li>\n<li>Significant exposure : &gt;30% <span class=\"customMeta\" data-dictid=\"c3b8b9a17416927771906b1bebb13c\">inclusion</span> in diet over 2-6 months</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clinical features</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Latent stage: <span class=\"customMeta\" data-dictid=\"e684325d851692777196af9e64013b\">preventive</span> can be best implemented here</li>\n<li>No stick stage: most common point of diagnosis</li>\n<li>One-stick stage: <span class=\"customMeta\" data-dictid=\"9e2d8a3f5a16927771932c2348ec52\">muscular</span> <span class=\"customMeta\" data-dictid=\"b52ddf2a451692777199b4d38e5c53\">stiffness</span> begins</li>\n<li>Two-stick stage: will need crutches</li>\n<li>Crawler stage: <span class=\"customMeta\" data-dictid=\"9e2d8a3f5a16927771932c2348ec52\">muscular</span> <span class=\"customMeta\" data-dictid=\"97ff5253fb169277718224c7b0faf8\">atrophy</span> sets in.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Treatment</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Vitamin C prophylaxis: 500-1000 mg per day</li>\n<li>Banning the crop</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Toxin removal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Steeping method: soaking in hot water for 2 hours, drained and sun-dried.</li>\n<li>Parboiling: overnight soaking in limewater.</li>\n<li>Genetic approach: selecting variants with less BOAA content and cultivating the same.</li>\n<li>Educating people.</li>\n<li>Bringing socio-economic changes.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What would be the most appropriate approach to managing a young male patient who has presented at the hospital with a clean-cut wound that is not bleeding, and who received a complete tetanus vaccination 10 years ago?", "options": [{"label": "A", "text": "Human tetanus immunoglobulin and full course of vaccine", "correct": false}, {"label": "B", "text": "Human tetanus immunoglobulin", "correct": false}, {"label": "C", "text": "Single-dose tetanus toxoid", "correct": true}, {"label": "D", "text": "Full course tetanus toxoid", "correct": false}], "correct_answer": "C. Single-dose tetanus toxoid", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:614px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Category</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Clean wound</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Unclean wound</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Category A</strong></p>\n<p>Has had a complete course of <span class=\"customMeta\" data-dictid=\"b895bf74681692777200571d1bd203\">toxoid</span> or a <span class=\"customMeta\" data-dictid=\"7725db2655169277718388f647e647\">booster</span> dose (full immunisation) within the past 5 years.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Only wound care.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Only wound care.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Category B</strong></p>\n<p>Full <span class=\"customMeta\" data-dictid=\"f5f07a3262169277718915163d31e3\">immunization</span> &gt; 5 years</p>\n<p>ago &lt; 10 years.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Wound Care + TT single dose.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Wound Care + TT single dose.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Category C</strong></p>\n<p>Full <span class=\"customMeta\" data-dictid=\"f5f07a3262169277718915163d31e3\">Immunization</span> &gt; 10 years</p>\n<p>ago.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Wound Care + TT single dose.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Wound Care + TT single dose + Human <span class=\"customMeta\" data-dictid=\"64dfe4fca51692777200a7ffbc44bb\">Tetanus</span> Immunoglobulin.</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Category D</strong></p>\n<p>Unknown, not known, never</p>\n<p>taken immunisation.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Wound Care + TT complete</p>\n<p>course.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Wound Care + TT complete</p>\n<p>course + Human Tetanus</p>\n<p>Immunoglobulin.</p>\n<p> </p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 16-year-old girl who experiences cyclical pelvic pain every month and has not yet experienced menarche presents to the clinic. On examination, there was a central suprapubic bulge. The swelling is in the anterior aspect on PR examination. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Transverse vaginal septum above the vagina", "correct": false}, {"label": "B", "text": "Vaginal atresia", "correct": false}, {"label": "C", "text": "Imperforate hymen", "correct": true}, {"label": "D", "text": "Cervical agenesis", "correct": false}], "correct_answer": "C. Imperforate hymen", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/o1VXUOUqNmvELhvTPBzX1745322651.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child presents with fever and rash. Urine examination shows cells with an \"owl-eye\" appearance. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Cytomegalovirus", "correct": true}, {"label": "B", "text": "Epstein-Barr virus", "correct": false}, {"label": "C", "text": "Herpes simplex virus", "correct": false}, {"label": "D", "text": "Toxoplasma gondii", "correct": false}], "correct_answer": "A. Cytomegalovirus", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Cytomegalovirus </strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>General Characteristics</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Herpesvirus (HHV-5)</strong>, widespread prevalence.</li>\n<li>Often <strong>asymptomatic</strong> in healthy individuals but severe in <strong>immunocompromised</strong> and <span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\">congenital</span> infections.</li>\n<li>Remains <strong>latent</strong> post-infection and may <strong>reactivate</strong>.</li>\n<li>Linked to <strong>mucoepidermoid carcinoma</strong> and possibly <strong>prostate cancer</strong>.</li>\n<li>Transmission: <strong>Blood transfusions, organ transplantation, breastfeeding, close contact, perinatal, and sexual routes</strong>.</li>\n<li><strong>Reactivation</strong> occurs in <span class=\"customMeta\" data-dictid=\"a3cc9f976916927771895692a1a8a0\">immunocompromised</span> individuals, increasing <strong>morbidity and mortality</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Persists in <span class=\"customMeta\" data-dictid=\"da88d7f2211692777193037caba514\">myeloid</span> cells</strong>, reactivates with <strong>immune suppression</strong>.</li>\n<li>Controlled mainly by <strong>cytotoxic T-cell immunity</strong>.</li>\n<li><strong>Lifelong immune burden</strong>, affecting <strong>T-cell surveillance</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Manifestations</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Immunocompetent patients:</strong> Often <span class=\"customMeta\" data-dictid=\"d1a9a79f701692777182066af09044\">asymptomatic</span> or <strong>mononucleosis-like syndrome</strong> (fever, rash, leukocytosis).</li>\n<li><strong>Immunocompromised patients:</strong> Can cause severe <strong>organ-specific disease</strong>:</li>\n<li><strong>CMV hepatitis</strong> → Risk of <strong>fulminant liver failure</strong></li>\n<li><strong>CMV retinitis</strong> → “<strong>Pizza pie</strong>” fundoscopic appearance</li>\n<li><strong>CMV esophagitis, colitis, pneumonitis, polyradiculopathy, encephalitis, <span class=\"customMeta\" data-dictid=\"a6260fa86416927772008d36bd7e5f\">transverse</span> myelitis</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Quantitative PCR</strong>: Preferred for <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> detection.</li>\n<li><strong>Histopathology (CMV <span class=\"customMeta\" data-dictid=\"c3b8b9a17416927771906b1bebb13c\">inclusion</span> bodies):</strong> Gold standard.</li>\n<li><strong>Serology:</strong> Used for <strong>pre-transplant risk assessment</strong> but <strong>not for <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> infection diagnosis</strong>.</li>\n<li><strong>CMV-negative blood transfusions</strong> reserved for neonates and <span class=\"customMeta\" data-dictid=\"a3cc9f976916927771895692a1a8a0\">immunocompromised</span> patients.</li>\n<li><strong>Ganciclovir resistance testing</strong> is routine in transplant centers.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Immunocompetent patients:</strong> Self-limiting, only <strong>symptomatic treatment</strong> required.</li>\n<li><strong>Immunocompromised &amp; severe cases:</strong> Require <strong>antivirals (ganciclovir, valganciclovir, foscarnet, cidofovir)</strong>.</li>\n<li><strong>Prophylaxis:</strong> CMV-negative recipients of <strong>CMV-positive organ transplants</strong> should receive <strong>valganciclovir or ganciclovir</strong> with <strong>serological monitoring</strong>.</li>\n<li><strong>Antiviral toxicity</strong> must be weighed against benefits.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "How is water collected for bacteriological examination during a disease outbreak?", "options": [{"label": "A", "text": "Collect water from already leaking taps", "correct": false}, {"label": "B", "text": "Before collecting, let water flow for at least 1 minute", "correct": false}, {"label": "C", "text": "Water sample container is kept close to the tap avoid spillage", "correct": false}, {"label": "D", "text": "Collect from a gentle stream of water to avoid splashing", "correct": true}], "correct_answer": "D. Collect from a gentle stream of water to avoid splashing", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A boys' hostel has an outbreak of fever cases with headache, followed by the development of pleomorphic rashes sparing palms and soles. What is the next best step in the management of suspected cases?", "options": [{"label": "A", "text": "Isolate for 6 days after giving acyclovir, followed by VZIG within 72 hours of exposure", "correct": false}, {"label": "B", "text": "Isolate for 12 days after giving acyclovir, followed by VZIG within 48 hours of exposure", "correct": false}, {"label": "C", "text": "Isolate for 6 days", "correct": true}, {"label": "D", "text": "Only give VZIG", "correct": false}], "correct_answer": "C. Isolate for 6 days", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Parameter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black\">\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Chickenpox</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Seasonal affinity: Winter season</li>\n<li>Etiology: HHV-3</li>\n<li>Route of transmission: <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> / <span class=\"customMeta\" data-dictid=\"c54afbcf861692777180adb352ee0d\">aerosol</span> route</li>\n<li>Age group affected: 5-9 years (school going age)</li>\n<li>Incubation period: 14-16 days</li>\n<li>Infectivity: 2 days prior to 5 days after the onset of rash</li>\n<li>SAR:&gt; 90%</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>Pre-eruptive stage:</strong> Sudden onset of mild to moderate fever lasting 2–3 days.</li>\n<li><strong>Eruptive stage: </strong>Centripetal, <span class=\"customMeta\" data-dictid=\"d391ed597c1692777195574de6cc11\">pleomorphic</span> <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> with \"Dew drop on rose petal\" appearance.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Complications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Adults/Immunosuppressed: Pneumonia.</li>\n<li>Maternal varicella: Low birth weight, microcephaly, cataract, deafness, <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> wastage.</li>\n<li>Secondary bacterial infection: Cellulitis, osteomyelitis, erysipelas.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>PCR: Detecting VZV DNA.</li>\n<li>Cell culture: From <span class=\"customMeta\" data-dictid=\"6b0184a84d16927771981289924c2a\">saliva</span> or <span class=\"customMeta\" data-dictid=\"43337a69ad169277720110a038f222\">vesicle</span> fluid.</li>\n<li>Tzanck smear: <span class=\"customMeta\" data-dictid=\"aa085932ce1692777193be7e5198bf\">Multinucleated</span> giant cells.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p><strong>Control and Prevention</strong></p>\n<p><strong>(Options A, B, and D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li><strong>Isolation:</strong> 6 days after <span class=\"customMeta\" data-dictid=\"dc75edd604169277719735ac5b4d5b\">rash</span> appearance.</li>\n<li><strong>Disinfection:</strong> Used specimens with <span class=\"customMeta\" data-dictid=\"802328b229169277719000601489eb\">infective</span> secretions.</li>\n<li><strong>Acyclovir:</strong> For adults to prevent complications; not indicated in children.</li>\n<li><strong>VZV Immunoglobulin: </strong>Within 72 hours of exposure, for immunosuppressed individuals.</li>\n<li><strong>Vaccine:</strong> 12–18 months of age; 0.5 ml <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> injection.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old homeless man presented with a 1-month history of fever, cough, and weight loss. Both sputum smears turned out to be negative, but the chest x-ray ordered was suggestive of tuberculosis. According to the recent NTEP guidelines, which is the next best line of management?", "options": [{"label": "A", "text": "Repeat sputum smears", "correct": false}, {"label": "B", "text": "Ask for CBNAAT", "correct": true}, {"label": "C", "text": "Ask for line probe assay", "correct": false}, {"label": "D", "text": "Wait until TB culture results to start ATT", "correct": false}], "correct_answer": "B. Ask for CBNAAT", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/g0Gn9nMUHDGeSOGDlcJA1745322987.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:648px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Diagnostic Modality</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Usage</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sputum <span class=\"customMeta\" data-dictid=\"6777533153169277719804fcbbf2d1\">Smear</span> Microscopy</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Microscopic examination of <span class=\"customMeta\" data-dictid=\"5353537f861692777199e48431cd88\">sputum</span> samples to detect <span class=\"customMeta\" data-dictid=\"440f2b916316927771808b8ad44a64\">acid-fast</span> <span class=\"customMeta\" data-dictid=\"fe0005a48b1692777182143f69e1d5\">bacilli</span> (AFB).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Used for initial screening and diagnosis, especially in resource-limited settings.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Chest X-ray</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Imaging done to identify abnormalities suggestive of TB.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Used to support diagnosis when clinical suspicion is high; not <span class=\"customMeta\" data-dictid=\"32b854324a1692777185c6c79fdc99\">definitive</span> for TB diagnosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>TruNAAT/CBNAAT</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Molecular tests that detect Mycobacterial DNA and <span class=\"customMeta\" data-dictid=\"6cd890fc7416927771978562618db8\">rifampicin</span> resistance.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Recommended for initial diagnosis due to high sensitivity and specificity; rapid results.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Line <span class=\"customMeta\" data-dictid=\"175eb86b5f16927771964d5ced6bf3\">Probe</span> <span class=\"customMeta\" data-dictid=\"fc026ff6d81692777182835f6de6df\">Assay</span> (LPA)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Molecular test to detect specific genetic mutations associated with <span class=\"customMeta\" data-dictid=\"36f0ccd0621692777186c1c3cecf48\">drug resistance</span> (e.g., rifampicin, isoniazid).</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Used for detecting <span class=\"customMeta\" data-dictid=\"36f0ccd0621692777186c1c3cecf48\">drug resistance</span> in confirmed TB cases, not for initial diagnosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Tuberculin Skin Test (TST)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>A skin test to measure <span class=\"customMeta\" data-dictid=\"dc6add5cf91692777189b30a6bae38\">immune response</span> to <span class=\"customMeta\" data-dictid=\"6a367ebd0c169277719091155a5b0f\">injected</span> <span class=\"customMeta\" data-dictid=\"0fe92012341692777201bab3db39b1\">tuberculin</span> protein.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Primarily used for screening <span class=\"customMeta\" data-dictid=\"cec2565ecd1692777191eed58869b2\">latent</span> TB infection; not specific for active TB diagnosis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Interferon-Gamma Release Assays (IGRAs)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Blood <span class=\"customMeta\" data-dictid=\"0ac01cc0c31692777185cae5f28175\">cytokine</span> analysis test that measures <span class=\"customMeta\" data-dictid=\"dc6add5cf91692777189b30a6bae38\">immune response</span> to TB antigens.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Used for detecting <span class=\"customMeta\" data-dictid=\"cec2565ecd1692777191eed58869b2\">latent</span> TB infection</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Sputum Culture</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Growing Mycobacteria from <span class=\"customMeta\" data-dictid=\"5353537f861692777199e48431cd88\">sputum</span> samples to confirm TB and test for drug susceptibility.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gold standard for TB diagnosis; takes several weeks to obtain results.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Drug <span class=\"customMeta\" data-dictid=\"6ced8252211692777199ab0cc3f2bb\">Susceptibility</span> Testing (DST)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Testing TB bacteria from patient samples to determine resistance to TB drugs.</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Used to guide treatment by identifying <span class=\"customMeta\" data-dictid=\"d4c88fcae71692777186aa1c32423a\">drug-resistant</span> strains in confirmed TB cases.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 17-year-old girl with a height of 155cm and weight of 48kgs presents with primary amenorrhea. She has not developed breasts or hair in the pubic or axillary regions and has bilateral inguinal masses. USG examination shows an absent uterus, fallopian tube, and ovary. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Hypergonadotropic hypogonadism", "correct": true}, {"label": "B", "text": "Complete androgen insensitivity syndrome", "correct": false}, {"label": "C", "text": "PCOS", "correct": false}, {"label": "D", "text": "Turner’s syndrome", "correct": false}], "correct_answer": "A. Hypergonadotropic hypogonadism", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Infection with Clonorchis sinensis is associated with an increased risk of which of the following cancers?", "options": [{"label": "A", "text": "Cervical cancer", "correct": false}, {"label": "B", "text": "Cholangiocarcinoma", "correct": true}, {"label": "C", "text": "Gastric carcinoma", "correct": false}, {"label": "D", "text": "Bladder carcinoma", "correct": false}], "correct_answer": "B. Cholangiocarcinoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/yyfCPeCn1KCmZm3wqrGo1745322928.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the sensitive indicator to assess the availability, utilization, and effectiveness of healthcare in a community?", "options": [{"label": "A", "text": "Infant mortality rate", "correct": true}, {"label": "B", "text": "Maternal mortality rate", "correct": false}, {"label": "C", "text": "Immunization coverage", "correct": false}, {"label": "D", "text": "Disability-adjusted life years", "correct": false}], "correct_answer": "A. Infant mortality rate", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:775px\">\n<tbody>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Crude death rate</strong></p>\n</td>\n<td rowspan=\"2\" style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p>CDR = (Total no. or deaths in a community/ MYP (Mid-year population) in the same area) x 100</p>\n<ul>\n<li>The mid-year population is taken on 1st July</li>\n<li>Limitation: It does not consider the age and sex of the population</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p><strong>Age-specific death rate </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p>ASDR = (Total no. of deaths in a particular age group (eg. 20-24yrs) a given area in a year/ MYP of the age group in the same area and year) x 1000</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p><strong>Expectation of life</strong></p>\n<p> </p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<ul>\n<li>Life <span class=\"customMeta\" data-dictid=\"9332897b901692777187ae9cd44351\">expectancy</span> at birth: A positive mortality indicator· Average no. of years a <span class=\"customMeta\" data-dictid=\"04df903fe8169277719383126b1b02\">newborn</span> is expected to live, considering the current age-specific mortality rates in a community.</li>\n<li>Important component to calculate the Human Development Index (HDI).</li>\n<li>Life <span class=\"customMeta\" data-dictid=\"9332897b901692777187ae9cd44351\">expectancy</span> at one year is PQLI. In 2021, life <span class=\"customMeta\" data-dictid=\"9332897b901692777187ae9cd44351\">expectancy</span> in India is <strong>69.7 years</strong>.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p><strong>Infant mortality rate </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p>IMR = (Total number of deaths (0-1-year-old) in a given year / Total number of live births in the same year) x 1000. It is a health status indicator.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p><strong>Under-five mortality rate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p>U5MR = (Total number of deaths (0-5 years old) in a given year /Total number of live births in one year) x 1000</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p><strong>Maternal Mortality Rate (Option B)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p>Maternal Mortality Rate (MMR) = (Total no. of <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> deaths/women in the <span class=\"customMeta\" data-dictid=\"11e24b369816927771974383c7e17c\">reproductive</span> age group [15-49 years]) x 100,000</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p><strong>Maternal Mortality Ratio (MMR)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p>Maternal Mortality <strong>Ratio </strong>(MMR) = (Total no. of <span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\">maternal</span> deaths/Live Births) x 100,000</p>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p><strong>Adult mortality rate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p>Probability of dying between 15 to 60 years of life</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p><strong>Year of potential life lost </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p>Premature death measurement. If life <span class=\"customMeta\" data-dictid=\"9332897b901692777187ae9cd44351\">expectancy</span> is 75 years, and death happens at age 30, then 45 years of potential life is lost</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p><strong>Proportional mortality rate </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p>The simplest measure of the burden of disease (Total deaths due to disease 'x'/ Total deaths in a community)́ x 100</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p><strong>Case fatality rate</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p>CFR = (Deaths due to diseases ‘z’ / total no of cases of disease ‘z’) x 100</p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:765px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<p><strong>Quality-adjusted Life Years (QALY)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:1px solid #9a9a9a; vertical-align:top\">\n<ul>\n<li>Quality and quantity of life lived.</li>\n<li>Assesses number of years of life added due to the intervention and hence the benefit and value for money of the intervention</li>\n<li>QALY - 1 year of life lived in <u>perfect</u> health</li>\n<li>Positive indicator of the cost-effectiveness of an intervention.</li>\n<li>Scored between 0 (death) and 1 (perfect health).</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p><strong>Disability-adjusted Life Years (DALY)</strong></p>\n<p><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<ul>\n<li>DALY= Years of life lost to <span class=\"customMeta\" data-dictid=\"84f13673191692777196762b18e036\">premature</span> death + years lived with disability</li>\n<li>1 DALY: 1 year of healthy life lost</li>\n<li>It is a measure of the burden of disease and the effectiveness of intervention<br/>\n\t\t\t\t </li>\n</ul>\n<p><strong>Year of life lost (YLL):</strong></p>\n<ul>\n<li>Calculated from the number of deaths at each age multiplied by the expected remaining years of life according to a global standard life expectancy.<br/>\n\t\t\t\t </li>\n</ul>\n<p><strong>Years lost to disability (YLD):</strong></p>\n<ul>\n<li>Where the number of incident cases due to injury and illness is multiplied by the average duration of the disease and a weighting factor reflecting the severity of the disease on a scale from 0 (perfect health) to 1 (dead).</li>\n</ul>\n<p> </p>\n<p><strong>DALY = YLL + YLD</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p><strong>Health Adjusted Life <span class=\"customMeta\" data-dictid=\"9332897b901692777187ae9cd44351\">Expectancy</span> (HALE)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<ul>\n<li>The average number of years a <span class=\"customMeta\" data-dictid=\"04df903fe8169277719383126b1b02\">newborn</span> is expected to live in full health considering the current age-specific mortality rate.<br/>\n\t\t\t\tHealthy Life Expectancy\n\t\t\t\t<ul>\n<li>HALE = Life <span class=\"customMeta\" data-dictid=\"9332897b901692777187ae9cd44351\">Expectancy</span> at birth + adjustment of time spent in poor health</li>\n<li>HALE = LE-DALY</li>\n</ul>\n</li>\n</ul>\n<p><strong>Life Expectancy</strong></p>\n<ul>\n<li>Average no. of years a <span class=\"customMeta\" data-dictid=\"04df903fe8169277719383126b1b02\">newborn</span> is expected to live, considering the current age-specific mortality rate.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:1px solid #9a9a9a; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<p><strong>Sullivan’s index<br/>\n\t\t\t(or DFLE)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #9a9a9a; border-left:none; border-right:1px solid #9a9a9a; border-top:none; vertical-align:top\">\n<ul>\n<li>Disability-free life <span class=\"customMeta\" data-dictid=\"9332897b901692777187ae9cd44351\">expectancy</span> (DFLE) with the current pattern of mortality and disability.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented with persistent dry cough, fever, and weight loss. He was diagnosed as HIV positive 6 months ago but has been poorly adherent to medications. Gomori methenamine silver (GMS) staining of bronchoalveolar lavage (BAL) reveals a crushed ping-pong ball appearance. What is the most likely causative organism?", "options": [{"label": "A", "text": "Paracoccidioides brasiliensis", "correct": false}, {"label": "B", "text": "Histoplasma capsulatum", "correct": false}, {"label": "C", "text": "Coccidioides immitis", "correct": false}, {"label": "D", "text": "Pneumocystis jirovecii", "correct": true}], "correct_answer": "D. Pneumocystis jirovecii", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Parameter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>HIV-Infected Patients</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Non-HIV Patients</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Onset</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Gradual (2 weeks to 2 months)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sudden (within a week)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Symptom Severity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Milder <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> <span class=\"customMeta\" data-dictid=\"afafb9026e1692777186e3dd168fa8\">distress</span> initially</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rapid <span class=\"customMeta\" data-dictid=\"3c305b384216927771969ca4166493\">progression</span> to <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> failure</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Course</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Chronic</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Acute</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Oxygen Impairment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Less severe</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>More severe</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A woman is to undergo a complete laparoscopic hysterectomy and wants to know about the disadvantages of the procedure. What are the disadvantages of laparoscopic hysterectomy over open surgery?", "options": [{"label": "A", "text": "Prolonged recovery time", "correct": false}, {"label": "B", "text": "Not knowing the extent of thermal burns", "correct": true}, {"label": "C", "text": "Increased bleeding", "correct": false}, {"label": "D", "text": "Increased pain", "correct": false}], "correct_answer": "B. Not knowing the extent of thermal burns", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A sewage worker presented with abdominal pain, jaundice, conjunctival injection, and hematuria for the past 5 days. Which of the following is the investigation of choice?", "options": [{"label": "A", "text": "Widal test", "correct": false}, {"label": "B", "text": "Microscopic agglutination test (MAT)", "correct": true}, {"label": "C", "text": "Weil-Felix reaction", "correct": false}, {"label": "D", "text": "Paul-Bunnell test", "correct": false}], "correct_answer": "B. Microscopic agglutination test (MAT)", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/uiqSlMUC0N9eMGG80FIS1745323483.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Leptospirosis</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Agent</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Leptospira interrogans (zoonotic bacteria)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Reservoir</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Rodents</strong> (Ratus norvegicus, <span class=\"customMeta\" data-dictid=\"18fd5724dc169277719319473a650b\">Mus</span> musculus) and domestic animals</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Source</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Direct contact or <span class=\"customMeta\" data-dictid=\"22b9188ade169277718581ce9dc589\">contamination</span> with <strong>excreta, <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">urine</span> of infected animals.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>At risk individuals</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Males 20-45 years (most common)</li>\n<li>Urine-contaminated mud(Soil) or water\n\t\t\t\t<ul>\n<li>Sports: Rafting, fishing and swimming</li>\n<li>Rice field workers, sewer workers, animal handlers</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mode of transmission</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Direct contact: <span class=\"customMeta\" data-dictid=\"0096f2a7631692777201eb9f21d5a7\">Urine</span> through skin abrasion</li>\n<li>Indirect contact: Contact of broken skin with soil, water, vegetation</li>\n<li>Droplet infection: Inhalation while <span class=\"customMeta\" data-dictid=\"5930026faa1692777192fce0743bff\">milking</span> cows.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Incubation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>4-20 days</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Diagnosis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Clinical features</li>\n<li><strong>Dark Field examination: </strong>Thin and <span class=\"customMeta\" data-dictid=\"27cf09e9d316927771928763e99e0d\">motile</span> <strong>spirochete</strong>.</li>\n<li>IgM <strong>ELISA</strong>: High sensitivity</li>\n<li>Labs: Elevated liver enzymes, increased <strong>bilirubin</strong>, <strong>thrombocytopenia</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During the removal of a submucosal fibroid by hysteroscopy, a deficit of 2000 mL is estimated in a patient. What is the immediate complication of this?", "options": [{"label": "A", "text": "Acute tubular necrosis", "correct": false}, {"label": "B", "text": "DIC", "correct": false}, {"label": "C", "text": "Pulmonary edema", "correct": true}, {"label": "D", "text": "Thromboembolism", "correct": false}], "correct_answer": "C. Pulmonary edema", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Distension media</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Feature </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Complications </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Carbon dioxide</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Highly <span class=\"customMeta\" data-dictid=\"845fedd06d16927771989597afa034\">soluble</span> in blood so poses less risk</li>\n<li>The flow rate must be below 100ml/min</li>\n<li>Insufflation pressure must be &lt; 100mmHg</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>CO<sub>2 </sub>emboli (rare)</li>\n<li>Intraoperative morbidity</li>\n<li>Death</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dextran 70</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hyperosmolar medium</li>\n<li>Volume used should be &lt; 300ml</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Allergic reaction (rare)</li>\n<li>Coagulopathy (rare)</li>\n<li>Vascular overload</li>\n<li>Heart failure</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low <span class=\"customMeta\" data-dictid=\"2313fc54841692777202a008c72950\">viscosity</span> fluids</p>\n<ul>\n<li>1.5% glycine</li>\n<li>3% sorbitol</li>\n<li>5% mannitol</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hypotonic</li>\n<li>Electrolyte free</li>\n</ul>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Absorption leads to major volume and <span class=\"customMeta\" data-dictid=\"2e0552462e16927771871413861fb7\">electrolyte</span> disturbances</li>\n<li>Pulmonary oedema</li>\n<li>Hyponatremia</li>\n<li>Heart failure</li>\n<li>Cerebral edema</li>\n<li>Death</li>\n<li>Cardiac and <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> <span class=\"customMeta\" data-dictid=\"d3323d4b271692777200122ea879e5\">toxicity</span> (from glycine)</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following laboratory tests is used to diagnose rotavirus diarrhea?", "options": [{"label": "A", "text": "Antigen detection in the stool sample", "correct": true}, {"label": "B", "text": "Antigen detection in blood", "correct": false}, {"label": "C", "text": "Antibody detection in serum", "correct": false}, {"label": "D", "text": "Light microscopy of stool specimen", "correct": false}], "correct_answer": "A. Antigen detection in the stool sample", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/F3nm7UwJlttWmQtobQ0H1745907157.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "For which of the following diagnoses in the given OT list would hysteroscopy be the preferred procedure?", "options": [{"label": "A", "text": "Tubal ligation", "correct": false}, {"label": "B", "text": "Asherman syndrome", "correct": true}, {"label": "C", "text": "Cervical polyp", "correct": false}, {"label": "D", "text": "Subserosal fibroid", "correct": false}], "correct_answer": "B. Asherman syndrome", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Hysteroscopy</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"> </p>\n<p style=\"text-align:center\"> </p>\n<p style=\"text-align:center\"> </p>\n<p style=\"text-align:center\"> </p>\n<p style=\"text-align:center\"> </p>\n<p style=\"text-align:center\"> </p>\n<p style=\"text-align:center\"> </p>\n<p style=\"text-align:center\"><strong>Indications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnostic:</strong></p>\n<ul>\n<li>AUB</li>\n<li>Infertility <strong>(Asherman syndrome) </strong></li>\n<li>Recurrent miscarriage<strong> (Asherman syndrome)</strong></li>\n<li>Congenital <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">Uterine</span> Anomalies</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Therapeutic:</strong></p>\n<ul>\n<li>Lost or displaced IUD</li>\n<li>Uterine septum</li>\n<li>Polyps</li>\n<li>Leiomyomas: It is preferred for fibroids below 5cm</li>\n<li>Endometrial ablation</li>\n<li>Hysteroscopic sterilization</li>\n<li>Intrauterine adhesions</li>\n<li>Proximal <span class=\"customMeta\" data-dictid=\"a970a38e85169277720171bea632e7\">tubal</span> obstruction</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"> </p>\n<p style=\"text-align:center\"> </p>\n<p style=\"text-align:center\"> </p>\n<p style=\"text-align:center\"><strong>Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Position: Modified <span class=\"customMeta\" data-dictid=\"51b29c48291692777186b488ac8cd9\">dorsal</span> lithotomy</li>\n<li>Cervical exposure</li>\n<li>Anesthesia: Based on the patient’s requirement</li>\n<li>Cervical dilation</li>\n<li>Uterine distention</li>\n<li>Visualization and imaging</li>\n<li>Intrauterine cutting and hemostasis</li>\n<li>Other instrumentation: Based on the patient's condition.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"> </p>\n<p style=\"text-align:center\"><strong>Contraindications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Active <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> or <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> infections</li>\n<li>Large <span class=\"customMeta\" data-dictid=\"59ff8b38191692777201150e72ebc3\">uterine</span> <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> ( &gt; 10 cm in length)</li>\n<li>Confirmed <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> or endometrial cancer</li>\n<li>Pregnancy.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A boy presented with fever and chills. A rapid test was positive for specific antigen HRP-2. Which of the following species of Plasmodium is the most likely causative agent?", "options": [{"label": "A", "text": "Plasmodium falciparum", "correct": true}, {"label": "B", "text": "Plasmodium malariae", "correct": false}, {"label": "C", "text": "Plasmodium vivax", "correct": false}, {"label": "D", "text": "Plasmodium ovale", "correct": false}], "correct_answer": "A. Plasmodium falciparum", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/gnV2Rw6wYUWblGv0AHcl1745324081.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Malaria</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Agent</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Plasmodium species</strong></p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Species</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Fever Cycle</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>P.falciparum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Malignant Tertian Malaria</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Every 48 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>P.vivax</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Benign Tertian Malaria</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Every 48 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>P.malariae</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Quartan Malaria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Every 72 hours</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>P.ovale</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ovale Malaria</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Every 48 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>P. knowlesi</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Quotidian Malaria</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Every 24 hours (daily)</p>\n</td>\n</tr>\n</tbody>\n</table>\n<p>Incubation Period: 7-30 days, depending on Plasmodium species</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Vector</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Female Anopheles mosquitoes</p>\n<ul>\n<li><strong>Behavior: Nocturnal feeders; </strong>prefer to bite between dusk and dawn</li>\n<li>Breeding Sites: Stagnant water bodies such as ponds, marshes, swamps, and artificial containers</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Transmission</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Bites of infected female Anopheles mosquitoes</li>\n<li><strong>Can be transmitted through blood transfusions and organ transplants.</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Host</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Humans (Primary Host)</li>\n<li>Higher risk in pregnant women, infants, and immunocompromised</li>\n<li>Anopheles mosquitoes (Vector and Intermediate host)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Environmental Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Climate: Warm and Humid environment</li>\n<li>Seasonality: Rainy seasons</li>\n<li>Geographical Distribution:\n\t\t\t\t<ul>\n<li><strong>Most prevalent in tropical and subtropical regions</strong></li>\n<li>India: Endemic in several states, particularly in the northeastern states (Assam, Tripura, Meghalaya), Eastern states (Odisha, Jharkhand), and some parts of Maharashtra and Karnataka</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Species</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Type </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Fever Cycle</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>P.falciparum</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Malignant Tertian Malaria</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Every 48 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>P.vivax</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Benign Tertian Malaria</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Every 48 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>P.malariae</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Quartan Malaria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Every 72 hours</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>P.ovale</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ovale Malaria</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Every 48 hours</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>P. knowlesi</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Quotidian Malaria</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Every 24 hours (daily)</p>\n</td>\n</tr>\n</tbody>\n\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\"> </td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Vivax </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Falciparum </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Malariae </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Ovale </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>RBC size </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Enlarged</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Normal</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Enlarged with frayed margins</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pigments </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Yellowish brown</p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Dark brown</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Schizont </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Large (9-10 μm)</p>\n<p>Fills the RBC</p>\n<p>Contains 12-24 merozoite</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Not seen in the periphery</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Small (6 μm), almost fills the RBC and contains 8 merozoites</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Gametocytes </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Spherical</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Crescentic</p>\n<p>Larger than RBC</p>\n</td>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Spherical</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ring <span class=\"customMeta\" data-dictid=\"a1b06f401f1692777203a53393ba98\">form</span> </strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2.5 μm</p>\n<p>Occupies ⅓ rd of RBC size</p>\n<p>Cytosol opposite to the <span class=\"customMeta\" data-dictid=\"ff628904401692777193c8a9f9159e\">nucleus</span> is thick</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>1.5 μm</p>\n<p>Occupies ⅙ of RBC size</p>\n<p>It may be</p>\n<ul>\n<li>Multiple forms</li>\n<li>Accole (attached to RBC membrane)</li>\n<li>Double dot/headphone shaped with fragment nucleus</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Band form</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2.5 μm</p>\n<p>Occupies ⅓ rd of RBC size</p>\n<p>Cytosol opposite to the <span class=\"customMeta\" data-dictid=\"ff628904401692777193c8a9f9159e\">nucleus</span> is thick</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>In Plasmodium falciparum, only <span class=\"customMeta\" data-dictid=\"36514f2a4416927771881b27e74758\">gametocyte</span> and ring forms are demonstrated in the PBS, as later stages of the <span class=\"customMeta\" data-dictid=\"7d53fd92541692777187195e87ab70\">erythrocytic</span> cycle occur in deep vessels and not in <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> blood.</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 23-year-old woman accompanied by her mother-in-law came to the infertility clinic. She has been having regular intercourse for 6 months but is not able to conceive. What is the next step in the management?", "options": [{"label": "A", "text": "Semen analysis for husband", "correct": false}, {"label": "B", "text": "Reassure and review the couple after 6 months", "correct": true}, {"label": "C", "text": "Hysterolaparoscopy", "correct": false}, {"label": "D", "text": "Diagnostic hysteroscopy", "correct": false}], "correct_answer": "B. Reassure and review the couple after 6 months", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Evaluation of <span class=\"customMeta\" data-dictid=\"e259c6641e1692777190c1be1c1842\">infertility</span> based on aetiologies </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Aetiology </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Evaluation </strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Ovulatory function/ ovarian reserve</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Ovulation predictor kit</li>\n<li>Early <span class=\"customMeta\" data-dictid=\"031a38f17a16927772036476ede2ae\">follicular</span> <span class=\"customMeta\" data-dictid=\"02315055441692777203a721dd9b19\">FSH</span> +/- <span class=\"customMeta\" data-dictid=\"d8cc09346f16927771878d48ba1ce8\">estradiol</span> level</li>\n<li>AMH level</li>\n<li>Endocrine disorders (TSH, prolactin)</li>\n<li>Ovarian <span class=\"customMeta\" data-dictid=\"2f728bd574169277719835f6456848\">sonography</span> (antral <span class=\"customMeta\" data-dictid=\"b0c3f6b8901692777203d0446fe1f4\">follicle</span> count)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tubal /pelvic disease</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hysterosalpingography</li>\n<li>Laparoscopy + chromotubation</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Uterine factors</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Hysterosalpingography</li>\n<li>TVS /saline <span class=\"customMeta\" data-dictid=\"3562d699c516927771909a426ea8ef\">infusion</span> <span class=\"customMeta\" data-dictid=\"2f728bd574169277719835f6456848\">sonography</span> +/- MRI</li>\n<li>Hysteroscopy +/- laparoscopy</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Male factor</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Semen analysis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child was brought with complaints of high fever, multiple seizures, headache, and neck rigidity. CSF analysis revealed low glucose, high protein, and many polymorphs. The CSF culture showed pleomorphic gram-negative bacilli. What is true about the causative organism?", "options": [{"label": "A", "text": "It is bacitracin sensitive", "correct": false}, {"label": "B", "text": "Produces non-lactose fermenting colonies on MacConkey agar", "correct": false}, {"label": "C", "text": "Exhibits satellitism around Staphylococcus aureus colonies", "correct": true}, {"label": "D", "text": "It exhibits alpha hemolysis on sheep blood agar", "correct": false}], "correct_answer": "C. Exhibits satellitism around Staphylococcus aureus colonies", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 24-year-old woman who is being treated for infertility with human menopausal gonadotropin came with complaints of sudden abdominal pain, nausea, vomiting, and breathlessness. USG reveals a classic spoke-wheel appearance. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Ovarian hyperstimulation syndrome", "correct": true}, {"label": "B", "text": "Polycystic ovarian syndrome", "correct": false}, {"label": "C", "text": "Theca lutein cysts", "correct": false}, {"label": "D", "text": "Granulosa cell tumor", "correct": false}], "correct_answer": "A. Ovarian hyperstimulation syndrome", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/ywBo2D6TvkVy5OJFDQQX1745911895.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A man presents with dysuria and urethral discharge after having unprotected sexual intercourse. Gram staining of the purulent discharge is shown in the image. What is the treatment of choice for this infection?", "options": [{"label": "A", "text": "Erythromycin", "correct": false}, {"label": "B", "text": "Ciprofloxacin + Azithromycin", "correct": false}, {"label": "C", "text": "Ceftriaxone + Azithromycin", "correct": true}, {"label": "D", "text": "Penicillin G", "correct": false}], "correct_answer": "C. Ceftriaxone + Azithromycin", "question_images": ["https://image.prepladder.com/content/DeF5ReZc6IiBNXzNy3uA1745324515.png"], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" rowspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Urethritis</strong></p>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Infectious Causes:</strong></p>\n<ul>\n<li>Neisseria gonorrhoeae (gonococcal)</li>\n<li>Chlamydia trachomatis (nongonococcal)</li>\n<li>Mycoplasma genitalium (recurrent urethritis)</li>\n<li>Trichomonas vaginalis (protozoal)</li>\n<li>Other: HSV, Treponema pallidum, Candida, Corynebacterium, Haemophilus influenzae</li>\n</ul>\n<p><strong>Non-Infectious Causes:</strong></p>\n<ul>\n<li>Irritants (soaps, spermicides, tight clothing)</li>\n<li>Trauma (catheterization, instrumentation)</li>\n<li>Menopause (low estrogen, atrophic vaginitis)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Symptoms:</strong>\n<ul>\n<li>Dysuria (worse in morning, alcohol-exacerbated)</li>\n<li>Urethral <span class=\"customMeta\" data-dictid=\"9dd87431ba1692777186ecfb21d258\">discharge</span> (varies by pathogen)</li>\n<li>Urethral pruritus, <span class=\"customMeta\" data-dictid=\"173bcd4a601692777194b27e05b5f7\">orchalgia</span> (testicular pain in men)</li>\n<li>Systemic symptoms rare (except <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> causes)</li>\n</ul>\n</li>\n<li><strong>Discharge Characteristics:</strong>\n<ul>\n<li>Thick, yellow-green → N. gonorrhoeae</li>\n<li>Clear, white → C. trachomatis</li>\n<li>Purulent/mucopurulent → M. genitalium</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical suspicion in sexually active individuals with urethral symptoms.</strong></p>\n<p><strong>Laboratory Tests:</strong></p>\n<ul>\n<li>Gram stain: Gram-negative <span class=\"customMeta\" data-dictid=\"a621be29da16927771901bc91014d1\">intracellular</span> <span class=\"customMeta\" data-dictid=\"32537c6fb21692777186a27701e42b\">diplococci</span> (gonococcal)</li>\n<li>NAAT (preferred): Detects C. trachomatis, N. gonorrhoeae, T. vaginalis, M. genitalium</li>\n<li>Additional: Cultures, fungal KOH prep, NAAT for syphilis/HIV, pregnancy testing, <span class=\"customMeta\" data-dictid=\"8bfe5df2c316927772026757237e09\">wet mount</span> for T. vaginalis (low sensitivity).</li>\n</ul>\n<p><strong>Alternative Methods:</strong></p>\n<ul>\n<li>MB/GV <span class=\"customMeta\" data-dictid=\"6777533153169277719804fcbbf2d1\">smear</span> (similar to <span class=\"customMeta\" data-dictid=\"f0347e3a7a1692777188cf90c50d6f\">gram</span> stain, sensitivity 97.3%)</li>\n<li>Urethral culture (for N. gonorrhoeae resistance testing)</li>\n<li>C. trachomatis suspected if <span class=\"customMeta\" data-dictid=\"53d0aa97fa1692777196817c1db471\">pyuria</span> present but no bacteria on stain/culture</li>\n<li>M. genitalium confirmed only via NAAT (limited availability)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Emerging Pathogens</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Haemophilus spp. increasingly <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to nongonococcal urethritis, especially with oral exposure.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Indications for Antibiotics:</strong></p>\n<ul>\n<li>Positive <span class=\"customMeta\" data-dictid=\"f0347e3a7a1692777188cf90c50d6f\">gram</span> stain/culture</li>\n<li>Contact with an infected partner</li>\n<li>Clinical <span class=\"customMeta\" data-dictid=\"e1bc35eee91692777201469005c140\">urethritis</span> without confirmed <span class=\"customMeta\" data-dictid=\"4711a65634169277718737b781005d\">etiology</span> if follow-up is uncertain.</li>\n</ul>\n<p><strong>Gonococcal Urethritis:</strong></p>\n<ul>\n<li><strong>Ceftriaxone 500 mg IM</strong> (if &lt;150 kg) or <strong>1 g IM</strong> (if ≥150 kg)</li>\n<li>If C. Trachomatis not ruled out: <strong>Add Doxycycline 100 mg PO BID x 7 days</strong></li>\n<li>Alternatives: Gentamicin + Azithromycin or Cefixime</li>\n</ul>\n<p><strong>Nongonococcal Urethritis:</strong></p>\n<ul>\n<li><strong>Doxycycline 100 mg PO BID x 7 days</strong> (preferred)</li>\n<li>Alternative: Azithromycin (multi-day better than single dose)</li>\n</ul>\n<p><strong>Persistent/Recurrent Urethritis:</strong></p>\n<ul>\n<li>M. genitalium suspected: <strong>Doxycycline 7 days → Moxifloxacin 400 mg PO daily x 7 days</strong></li>\n<li>If T. vaginalis suspected: <strong>NAAT confirmation or <span class=\"customMeta\" data-dictid=\"f6a1e7d76a16927771874857c00281\">empiric</span> Metronidazole 2 g PO</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Special Cases</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pregnancy:</strong></p>\n<ul>\n<li><strong>Azithromycin 1 g PO</strong> (preferred)</li>\n<li>Alternatives: Amoxicillin, Erythromycin (varied dosing)</li>\n<li><strong>Avoid:</strong> Doxycycline, Quinolones</li>\n</ul>\n<p><strong>Resistant M. Genitalium</strong>: Moxifloxacin or Pristinamycin</p>\n<p><strong>T. vaginalis Treatment:</strong></p>\n<ul>\n<li><strong>Women:</strong> Metronidazole 500 mg PO BID x 7 days</li>\n<li><strong>Men:</strong> Metronidazole 2 g PO single dose</li>\n<li><strong>Sexual partners must be treated to prevent reinfection.</strong></li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A primigravida presents to you with anaemia early in her pregnancy. She is 7 weeks pregnant, as seen on ultrasound. Her haemoglobin level is 9 gm%. When should the iron supplements be started for her?", "options": [{"label": "A", "text": "10 to 12 weeks", "correct": false}, {"label": "B", "text": "8 to 10 weeks", "correct": true}, {"label": "C", "text": "After 14 weeks", "correct": false}, {"label": "D", "text": "After 20 weeks", "correct": false}], "correct_answer": "B. 8 to 10 weeks", "question_images": [], "explanation_images": [], "explanation": "<table align=\"center\" cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black\">\n<p style=\"text-align:center\"><strong>Anaemia management protocol for pregnant women</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Target Group</p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>Pregnant women registered for <span class=\"customMeta\" data-dictid=\"42bfa0b99f16927771817ed9a23b27\">antenatal</span> care</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Screening and Periodicity</p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none\">\n<p>By health service provider at every ANC checkup</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p style=\"text-align:center\"><strong>Degree</strong></p>\n<p style=\"text-align:center\"><strong>Of anaemia</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>First Level of Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Follow-up</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>If No Improvement</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Mild anaemia (Hb 10–10.9 g/dl)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Two Iron and <span class=\"customMeta\" data-dictid=\"778971b8f5169277720391773cc8fa\">Folic Acid</span> tablets (60 mg elemental Iron and 500 <span class=\"customMeta\" data-dictid=\"321808298216927771927f9e8e7f8f\">mcg</span> Folic Acid)<strong> </strong>daily, orally given by health provider.</li>\n<li>Parenteral iron (IV <span class=\"customMeta\" data-dictid=\"80a425f1c21692777190faced3c15b\">Iron Sucrose</span> or <span class=\"customMeta\" data-dictid=\"5a046503cb169277720259dec3f2be\">Ferric</span> <span class=\"customMeta\" data-dictid=\"def83d36b61692777183a5db9b27af\">Carboxy</span> Maltose) may be considered for late pregnancy or low compliance cases</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Every 2 months for treatment compliance.</li>\n<li>Discontinue treatment if Hb levels normalize, continue <span class=\"customMeta\" data-dictid=\"a87d6eeedb16927771967434e19075\">prophylactic</span> <span class=\"customMeta\" data-dictid=\"ac3b9c5a1916927771891bd2416218\">IFA</span> dose</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Refer to First Referral Unit (FRU)/District Hospital (DH) if Hb &lt;1 g/dl increases after one month of treatment. Further investigation and management with IV Iron Sucrose/FCM</li>\n</ul>\n<p> </p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Moderate anaemia (Hb 7–9.9 g/dl)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Two Iron and <span class=\"customMeta\" data-dictid=\"778971b8f5169277720391773cc8fa\">Folic Acid</span> tablets (60 mg elemental Iron and 500 <span class=\"customMeta\" data-dictid=\"321808298216927771927f9e8e7f8f\">mcg</span> Folic Acid) daily, orally given by health provider.</li>\n<li>Parenteral iron (IV <span class=\"customMeta\" data-dictid=\"80a425f1c21692777190faced3c15b\">Iron Sucrose</span> or <span class=\"customMeta\" data-dictid=\"5a046503cb169277720259dec3f2be\">Ferric</span> <span class=\"customMeta\" data-dictid=\"def83d36b61692777183a5db9b27af\">Carboxy</span> Maltose) may be considered for late pregnancy or low compliance cases.<strong> </strong></li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Every 2 months for treatment compliance. Monthly Hb estimation. Discontinue treatment if Hb levels normalize, continue <span class=\"customMeta\" data-dictid=\"a87d6eeedb16927771967434e19075\">prophylactic</span> <span class=\"customMeta\" data-dictid=\"ac3b9c5a1916927771891bd2416218\">IFA</span> dose.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Refer to FRU/DH if Hb &lt;1 g/dl increases after two months of treatment. Further investigation and management with IV Iron Sucrose/FCM</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none\">\n<p>Severe anaemia (Hb 5.0–6.9 g/dl)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Managed by the medical officer at PHC/CHC/FRU/DH.</li>\n<li>Treatment with IV Iron Sucrose/Ferric Carboxymaltose.</li>\n<li>Immediate <span class=\"customMeta\" data-dictid=\"277d6f3ee2169277718938e321258f\">hospitalization</span> in the third <span class=\"customMeta\" data-dictid=\"2c20f0f1dd169277720029d29458d5\">trimester</span> is recommended at a higher facility.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Monthly or as prescribed by the medical officer</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Follow treatment protocol as prescribed by the medical officer</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented with high fever, altered sensorium, headache, neck rigidity, and seizures. He was diagnosed with HSV encephalitis. Which of the following tests can be used to confirm the diagnosis?", "options": [{"label": "A", "text": "IgM in CSF", "correct": false}, {"label": "B", "text": "Tzanck smear of CSF", "correct": false}, {"label": "C", "text": "CSF PCR for viral DNA", "correct": true}, {"label": "D", "text": "CSF culture on chick embryo lines", "correct": false}], "correct_answer": "C. CSF PCR for viral DNA", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>HSV Encephalitis</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Herpesviruses: Large, double-stranded DNA viruses; 8 types affect humans (HHV-1 to HHV-8).</li>\n<li>HSV Types:\n\t\t\t\t<ul>\n<li>HSV-1: Most common in adults &amp; children; sporadic, non-seasonal.</li>\n<li>HSV-2: More common in neonates &amp; <span class=\"customMeta\" data-dictid=\"a3cc9f976916927771895692a1a8a0\">immunocompromised</span> individuals.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Etiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Causative Agents: HSV-1 (90%), HSV-2 (10%).</li>\n<li>Structure: Enveloped, icosahedral, double-stranded DNA virus.</li>\n<li>Host Cell Entry: Via nectin-1 and HVEM receptors on neurons.</li>\n<li>Pathogenesis:\n\t\t\t\t<ul>\n<li>Primary infection: <span class=\"customMeta\" data-dictid=\"17df0c44e116927771897deca1bbf4\">HSV</span> infects skin/mucosa, enters neurons, and travels retrogradely to ganglia.</li>\n<li>Latency: Controlled by immune mechanisms (histone deposition, cytokines).</li>\n<li>Reactivation: Can spread to <span class=\"customMeta\" data-dictid=\"e1a4a12fb416927771841c46faf6fb\">CNS</span> via <span class=\"customMeta\" data-dictid=\"6d1eb38ecf1692777200bb65bbdefb\">trigeminal</span> or <span class=\"customMeta\" data-dictid=\"30cac2b1a216927771941c69ff66a3\">olfactory</span> nerves.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Transmission: Close contact; HSV-1 → oral, HSV-2 → genital.</li>\n<li>Brain Invasion Routes:\n\t\t\t\t<ol>\n<li>Oropharyngeal infection → Trigeminal/Olfactory nerve spread.</li>\n<li>Reactivation in <span class=\"customMeta\" data-dictid=\"f2804c808516927771887dda93e56c\">ganglia</span> → <span class=\"customMeta\" data-dictid=\"e1a4a12fb416927771841c46faf6fb\">CNS</span> spread.</li>\n<li>Latent <span class=\"customMeta\" data-dictid=\"17df0c44e116927771897deca1bbf4\">HSV</span> in the brain reactivates.</li>\n</ol>\n</li>\n<li>Affected Areas: <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">Temporal</span> lobes, <span class=\"customMeta\" data-dictid=\"fae243395d16927771917dbd1992e9\">limbic</span> system → hemorrhagic necrosis.</li>\n<li>Immunosuppression Risks: Natalizumab, TNF-α inhibitors, whole-brain radiation.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Clinical Presentation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Prodrome: Fever, malaise, headache, nausea.</li>\n<li>Typical Features:\n\t\t\t\t<ul>\n<li>CNS signs: Confusion, seizures, <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> deficits, personality changes.</li>\n<li>Behavioral syndromes: Hypomania, Klüver-Bucy, amnesia.</li>\n<li>Other findings: Incontinence, dermatomal rash, Guillain-Barré syndrome.</li>\n</ul>\n</li>\n<li>Neonatal HSE:\n\t\t\t\t<ul>\n<li>Presents at 1–3 weeks with irritability, lethargy, poor feeding, tremors, seizures.</li>\n<li>Herpetic skin lesions, thrombocytopenia, liver <span class=\"customMeta\" data-dictid=\"3662597407169277718640a12868f5\">dysfunction</span> may be present.</li>\n</ul>\n</li>\n<li>Immunocompromised Patients: Atypical/subtle presentation, fewer <span class=\"customMeta\" data-dictid=\"da6db7b0e21692777203c4075458d3\">focal</span> deficits.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Histopathology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Gross Findings: Hemorrhagic <span class=\"customMeta\" data-dictid=\"5e84a7987c16927771931012aced83\">necrosis</span> in <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">temporal</span> and <span class=\"customMeta\" data-dictid=\"49c4ef5b9d1692777190c0277f8344\">inferior</span> <span class=\"customMeta\" data-dictid=\"35aa36279d16927772031c7ce8d6e5\">frontal</span> lobes.</li>\n<li>Microscopic Findings:\n\t\t\t\t<ul>\n<li>Early: Neuronal ischemia, <span class=\"customMeta\" data-dictid=\"89e3252d5b16927771833fb9b432ae\">capillary</span> dilation.</li>\n<li>Cowdry <span class=\"customMeta\" data-dictid=\"10b0d1c12d16927772018830011368\">type A</span> inclusions: <span class=\"customMeta\" data-dictid=\"91bc3a9b3e16927771871bcff74db7\">Eosinophilic</span> <span class=\"customMeta\" data-dictid=\"9a24821bc91692777190bba334f1a6\">intranuclear</span> inclusions in neurons.</li>\n<li>Late (&gt;3 weeks): Necrosis, gliosis, inflammation.</li>\n</ul>\n</li>\n<li>Atypical in Immunocompromised: Less inflammation, persistent <span class=\"customMeta\" data-dictid=\"5cc2d9fac616927772021889ee6d52\">viral</span> antigens.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Evaluation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>CSF Analysis (Gold Standard):</strong>\n<ul>\n<li>↑ WBCs (lymphocytic pleocytosis), ↑ protein, normal glucose.</li>\n<li><strong>HSV PCR: 96% sensitive, 99% specific.</strong></li>\n<li>Repeat <span class=\"customMeta\" data-dictid=\"fa67319b42169277719498abc93db6\">PCR</span> if negative within 72 hours in high-suspicion cases.</li>\n<li><strong>HSV <span class=\"customMeta\" data-dictid=\"e4a6fd7fbb169277718986a699e800\">IgM</span> in <span class=\"customMeta\" data-dictid=\"123c47549916927771854892334fb9\">CSF</span> is useful if <span class=\"customMeta\" data-dictid=\"fa67319b42169277719498abc93db6\">PCR</span> is unavailable or delayed.</strong></li>\n</ul>\n</li>\n<li>Imaging:\n\t\t\t\t<ul>\n<li>CT: Initial test; may be normal early, later shows hypodensities, hemorrhage.</li>\n<li>MRI (Best Test): <span class=\"customMeta\" data-dictid=\"637ea4d17516927772003be2b2aae4\">Temporal</span> <span class=\"customMeta\" data-dictid=\"d7dd6ae43c1692777191cf75c0bd58\">lobe</span> hyperintensities on T2/FLAIR, sparing <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> ganglia.</li>\n</ul>\n</li>\n<li>Other Tests:\n\t\t\t\t<ul>\n<li>CBC, <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> panel.</li>\n<li>HSV <span class=\"customMeta\" data-dictid=\"fa67319b42169277719498abc93db6\">PCR</span> in blood useful in neonates &amp; immunocompromised.</li>\n</ul>\n</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A pregnant woman comes to the GYN OPD with a positive UPT test result. She already has twins by normal delivery. Which of the following is the correct representation of her obstetric score?", "options": [{"label": "A", "text": "G3P2", "correct": false}, {"label": "B", "text": "G3P1", "correct": false}, {"label": "C", "text": "G2P1", "correct": true}, {"label": "D", "text": "G2P2", "correct": false}], "correct_answer": "C. G2P1", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Gravida</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Denotes a pregnant state both present and past, irrespective of the period of gestation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Parity</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Denotes a state of previous pregnancy beyond the period of viability(28 weeks)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Abortion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Number of pregnancies lost before 24 weeks</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Living</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Number of living children</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 27-year-old pregnant G3P2L2 woman presents at 36+6 weeks. The ultrasound shows the fetus in a transverse lie. The liquor is adequate, the placenta is normal, and she has no risk factors. Both her previous delivery were normal vaginal deliveries. How will you manage this patient?", "options": [{"label": "A", "text": "Cesarean section", "correct": false}, {"label": "B", "text": "External cephalic version", "correct": true}, {"label": "C", "text": "Expectant management", "correct": false}, {"label": "D", "text": "Induction of labour", "correct": false}], "correct_answer": "B. External cephalic version", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Answer B - External &lt;span class=\"customMeta\" data-dictid=\"3b78d9438716927771841c88afb16c\"&gt;cephalic&lt;/span&gt; v\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What should be the subsequent course of action in managing a patient who presents with fever and a positive filarial antigen test?", "options": [{"label": "A", "text": "Bone marrow biopsy", "correct": false}, {"label": "B", "text": "DEC provocation test", "correct": false}, {"label": "C", "text": "Detection of microfilariae in the blood smear", "correct": true}, {"label": "D", "text": "Ultrasound of the scrotum", "correct": false}], "correct_answer": "C. Detection of microfilariae in the blood smear", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/C4CwRbCClB7ODvuw9nh81745325500.png", "https://image.prepladder.com/content/1NXB5oIOGhABO60tT53a1745325522.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td colspan=\"5\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Diagnosis of filariasis</strong></p>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>1.</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Thick blood film</strong><br/>\n<strong>(Investigation of choice)</strong></p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Nocturnal microfilariae are seen in blood between 10 PM to 2 AM</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lymphatic filariasis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Brugian/Malayan filariasis</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Large, smooth (graceful) curve with countable nuclei</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"Ullah, Muhammad &amp; Al Balushi, Ahmed &amp; Aliyani, Nader &amp; Kalarikkal, Biju &amp; Miranda, Reeher &amp; Mohamed, Sherif &amp; Habsi, Ahmed &amp; Saidi, Eman &amp; Anver, Adil &amp; Qassem, Nouraldeen.\" data-hash=\"\" data-license=\"CC BY 4.0\" data-source=\"https://www.researchgate.net/figure/Full-Size-Microfilaria-Wuchereria-Bancrofti-seen-on-thick-blood-smear-stained-with_fig1_340704206\" data-tags=\"\" height=\"300\" src=\"https://image.prepladder.com/content/C4CwRbCClB7ODvuw9nh81745325500.png\" width=\"300\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Small, kinked at an <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> angle with a long head and uncountable nuclei</p>\n<div style=\"text-align:center\">\n<figure class=\"caption_element\" style=\"display:inline-block\"><img alt=\"\" data-author=\"NA\" data-hash=\"\" data-license=\"Open access\" data-source=\"https://picryl.com/media/brugia-malayi-de356c\" data-tags=\"\" height=\"251\" src=\"https://image.prepladder.com/content/1NXB5oIOGhABO60tT53a1745325522.png\" width=\"200\"/>\n<figcaption>{{caption_text}}</figcaption>\n</figure>\n</div>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>2.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Rapid <span class=\"customMeta\" data-dictid=\"723fdec66b1692777186e92f0c6fdf\">Detection</span> Test</p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Also called the <strong>filarial strip test</strong></li>\n<li>Used for <strong>monitoring</strong>, mapping, and evaluation activities</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>3.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Membrane filter concentration method</p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Most sensitive methods for detecting low-density microfilaraemia</li>\n<li>Require specialized equipment.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>4.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>DEC <span class=\"customMeta\" data-dictid=\"80806f031b1692777196a8db8c148e\">provocation</span> test:</p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>A single oral dose of 100mg DEC followed by blood <span class=\"customMeta\" data-dictid=\"6777533153169277719804fcbbf2d1\">smear</span> after 1 hour</li>\n<li>Microfilariae can appear in the daytime.</li>\n<li><strong>Highest <span class=\"customMeta\" data-dictid=\"e70dd3ea9916927771988faba61d64\">specificity</span> </strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>5.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Serological tests</p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Cannot <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> between past and present infection</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>6.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Mass blood survey</p>\n</td>\n<td colspan=\"3\" style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Thick blood films for epidemiological Survey</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A woman presents to you at 36 weeks of gestation with complaints of breathlessness and excessive abdominal distension. Fetal movements are normal on examination, fetal parts are not easily felt, and fetal heartbeat is heard but muffled. Her symphysis-fundal height is 41 cm. Her abdomen is tense but not tender. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Abruptio placenta", "correct": false}, {"label": "B", "text": "Hydrocephalus of fetus", "correct": false}, {"label": "C", "text": "Polyhydramnios", "correct": true}, {"label": "D", "text": "Fetal-maternal ascites", "correct": false}], "correct_answer": "C. Polyhydramnios", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Causes</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Polyhydramnios</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Fetal Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Fetal anomalies (e.g., anencephaly, <span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\">esophageal</span> atresia) <strong>(Option A)</strong></li>\n<li>Twin-to-twin <span class=\"customMeta\" data-dictid=\"cbb73554631692777200444a9ea263\">transfusion</span> syndrome (TTTS)</li>\n<li>Hydrops fetalis</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Maternal Factors</strong></p>\n</td>\n<td rowspan=\"3\" style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Diabetes mellitus</li>\n<li>Cardiac disease</li>\n<li>Renal disease</li>\n</ul>\n</td>\n</tr>\n<tr>\n</tr>\n<tr>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Placental Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Chorioangioma</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female presents to you with 6 weeks of amenorrhea, complaining of bleeding per vagina and slight abdominal pain. The urine pregnancy test is slightly positive, and the hCG level is 2800 IU/L. A mass is seen on the left adnexa measuring 3 x 2.5 cm. She is hemodynamically stable. How will you manage this patient?", "options": [{"label": "A", "text": "Oral methotrexate", "correct": false}, {"label": "B", "text": "Single-dose methotrexate injection", "correct": true}, {"label": "C", "text": "Serial methotrexate + leucovorin rescue", "correct": false}, {"label": "D", "text": "Salpingectomy", "correct": false}], "correct_answer": "B. Single-dose methotrexate injection", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Management </strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Criteria/Indication</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Description</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Expectant Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Beta <span class=\"customMeta\" data-dictid=\"40c2e3a3911692777188ff9957c2ef\">hCG</span> &lt; 1,500 IU/L<br/>\n\t\t\t\tAnd falling subsequent levels</li>\n<li>No significant symptoms</li>\n<li>Strong likelihood of <span class=\"customMeta\" data-dictid=\"f71e485d131692777199151d1076d2\">spontaneous</span> resolution</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Monitoring without intervention, relying on the natural resolution of the <span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\">ectopic</span> pregnancy.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Medical Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Beta <span class=\"customMeta\" data-dictid=\"40c2e3a3911692777188ff9957c2ef\">hCG</span> &lt; 3,000 IU/L</li>\n<li>Adnexal mass &lt; 4 cm</li>\n<li>No <span class=\"customMeta\" data-dictid=\"f375a3584316927772020efa386e3e\">fetal</span> <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> activity</li>\n<li>Hemodynamically stable</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Methotrexate (single dose/ multi-dose regimen) (best)</strong></li>\n<li><strong>KCl (directly in sac)</strong></li>\n<li>Mifepristone</li>\n<li>Prostaglandins</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p style=\"text-align:center\"><strong>Surgical Management</strong></p>\n<p style=\"text-align:center\"><strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Beta <span class=\"customMeta\" data-dictid=\"40c2e3a3911692777188ff9957c2ef\">hCG</span> &gt; 5,000 IU/L</li>\n<li>Size of <span class=\"customMeta\" data-dictid=\"0decefe0901692777186f7f3f89b2a\">ectopic</span> &gt; 4 cm</li>\n<li>Presence of <span class=\"customMeta\" data-dictid=\"e1fb96fd2416927771830dfed40e14\">cardiac</span> activity</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li><strong>Linear <span class=\"customMeta\" data-dictid=\"61fda112f41692777198f6f3b8535f\">Salpingostomy</span> (best)</strong></li>\n<li>Resection Anastomosis</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A woman presents to you at 36 weeks of gestation with complaints of feeling lightheadedness and dizziness when she lies on her back. She says she feels alright if she lies on her side or when she walks. What is the most likely reason behind this?", "options": [{"label": "A", "text": "Increased intracranial pressure", "correct": false}, {"label": "B", "text": "IVC compression (IVC- Inferior Vena Cava)", "correct": true}, {"label": "C", "text": "Heavy meals", "correct": false}, {"label": "D", "text": "Excessive venous pooling at the feet", "correct": false}], "correct_answer": "B. IVC compression (IVC- Inferior Vena Cava)", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/px4MKpjTsbQttCBr75b21745326984.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A partogram of a woman who is in labor is shown below. Oxytocin infusion is already given. How will you manage the condition?", "options": [{"label": "A", "text": "Forceps-assisted delivery", "correct": false}, {"label": "B", "text": "Vacuum-assisted delivery", "correct": false}, {"label": "C", "text": "Oxytocin infusion", "correct": false}, {"label": "D", "text": "Cesarean section", "correct": true}], "correct_answer": "D. Cesarean section", "question_images": ["https://image.prepladder.com/notes/710Y9OO3wjKJsJz5vuf61745911896.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A woman comes with complaints of pain and swelling in the perianal area. She also has complaints of difficulty in walking and sitting. She gives a history of multiple sexual partners. On examination, tender swelling is seen with redness on the labia, as shown in the image given below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Chlamydial infection", "correct": false}, {"label": "B", "text": "Bartholin abscess", "correct": true}, {"label": "C", "text": "Genital tuberculosis", "correct": false}, {"label": "D", "text": "Herpes infection", "correct": false}], "correct_answer": "B. Bartholin abscess", "question_images": ["https://image.prepladder.com/content/LUUiTBXzPMKq2eYJuCz71745327519.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Please identify the manoeuvre being executed in the image provided.", "options": [{"label": "A", "text": "Head tilt, chin lift", "correct": true}, {"label": "B", "text": "Jaw thrust", "correct": false}, {"label": "C", "text": "Head extension", "correct": false}, {"label": "D", "text": "In-line manual stabilization", "correct": false}], "correct_answer": "A. Head tilt, chin lift", "question_images": ["https://image.prepladder.com/notes/keb0chSAZb5hR2s7TqVe1745911456.jpg"], "explanation_images": ["https://image.prepladder.com/notes/keb0chSAZb5hR2s7TqVe1745911456.jpg", "https://image.prepladder.com/notes/XRfszIbpupl1KpDVqxyM1745911455.jpg"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the drug of choice for preoperative antibiotic prophylaxis in a patient undergoing cardiac surgery?", "options": [{"label": "A", "text": "Penicillin G", "correct": false}, {"label": "B", "text": "Erythromycin", "correct": false}, {"label": "C", "text": "Azithromycin", "correct": false}, {"label": "D", "text": "Cefazolin", "correct": true}], "correct_answer": "D. Cefazolin", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td colspan=\"4\" style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Antibiotic <span class=\"customMeta\" data-dictid=\"bc36e9b9381692777196b5f9a2f79c\">Prophylaxis</span> Before Surgery</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type of Procedure</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common Pathogens</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Preferred Regimen</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Severe beta-lactam allergy, or high risk of MRSA</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cardiac</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Staphylococcus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cefazolin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Vancomycin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Gastrointestinal (Esophageal, <span class=\"customMeta\" data-dictid=\"5f1eca7eaa1692777188e4f8827ef9\">gastroduodenal</span> <span class=\"customMeta\" data-dictid=\"9a1def52471692777195f66cc715bf\">PEG</span> placement)</p>\n<p>Biliary, including lap cholecystectomy</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Enteric gramnegative bacilli, grampositive cocci</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cefazolin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clindamycin</p>\n<p>+</p>\n<p>Gentamicin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Colorectal</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Enteric GNR, Enterococcus, Anaerobes, Staphylococcus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cefoxitin OR Ceftriaxone</p>\n<p>+</p>\n<p>Metronidazole</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clindamycin</p>\n<p>+</p>\n<p>Gentamicin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Head and neck surgery including oral surgery</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Anaerobes, <span class=\"customMeta\" data-dictid=\"85c304623c1692777187da4d1f1ee7\">enteric</span> <span class=\"customMeta\" data-dictid=\"f0347e3a7a1692777188cf90c50d6f\">gram</span> negative bacilli, S.aureus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cefazolin</p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clindamycin</p>\n<p>+</p>\n<p>Gentamicin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Neurosurgery</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>S.epidermidis,</p>\n<p>S. aureus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cefazolin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Vancomycin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Thoracic (Lung resection, VATS)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>S. aureus, S. epidermidis, streptococci, <span class=\"customMeta\" data-dictid=\"85c304623c1692777187da4d1f1ee7\">enteric</span> gramnegative bacilli</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cefazolin</p>\n<p>OR</p>\n<p>Clindamycin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Vancomycin</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Genotiurinary</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Enteric gramnegative bacilli, anaerobes, enterococci</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cefazolin OR</p>\n<p>Cefoxitin</p>\n<p>OR</p>\n<p>Ampicillin</p>\n<p>+</p>\n<p>Metronidazole</p>\n<p>+</p>\n<p>Gentamicin</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Clindamycin</p>\n<p>+</p>\n<p>Gentamicin</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "When should the indicated position be used during resuscitation?", "options": [{"label": "A", "text": "Unconsciousness with pulse absent and breathing absent", "correct": false}, {"label": "B", "text": "Unconsciousness with pulse present and breathing absent", "correct": false}, {"label": "C", "text": "Unconsciousness with pulse and breathing present", "correct": true}, {"label": "D", "text": "Unconsciousness with pulse absent and breathing present", "correct": false}], "correct_answer": "C. Unconsciousness with pulse and breathing present", "question_images": ["https://image.prepladder.com/notes/iFWagRYNl3CLlVpQNqQF1745911456.jpg"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 210 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 200 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "Which of the following medications is most commonly used for maintenance therapy in opioid withdrawal?", "options": [{"label": "A", "text": "Buprenorphine", "correct": true}, {"label": "B", "text": "Naloxone", "correct": false}, {"label": "C", "text": "Naltrexone", "correct": false}, {"label": "D", "text": "Acamprosate", "correct": false}], "correct_answer": "A. Buprenorphine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Buprenorph\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An elderly patient presents with elevated calcium levels, increased serum creatinine levels, and decreased hemoglobin. Electrophoresis reveals a monoclonal spike. Her immunofixation test findings are given below. Which of the following best describes her condition?", "options": [{"label": "A", "text": "MM with increased IgG", "correct": false}, {"label": "B", "text": "MM with increased IgM", "correct": true}, {"label": "C", "text": "MM with increased IgA", "correct": false}, {"label": "D", "text": "Monoclonal gammopathy of unknown significance", "correct": false}], "correct_answer": "B. MM with increased IgM", "question_images": ["https://image.prepladder.com/content/Q58KA5OrdG9v2xAZBggY1724833522.png"], "explanation_images": ["https://image.prepladder.com/content/mHn0GToUJ1X1fFlCqA131724911761.png", "https://image.prepladder.com/content/691sDAKnEwbY0HWALAkM1726817925.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 50-year-old woman presents with a mass felt on the perineum. On examination, a palpable uterus is noted, and from the os, one finger can pass. She delivered 20 years ago.What is the most likely diagnosis?", "options": [{"label": "A", "text": "Myxomatous Polyp", "correct": true}, {"label": "B", "text": "Uterine Inversion", "correct": false}, {"label": "C", "text": "Placental Polyp", "correct": false}, {"label": "D", "text": "Hypertrophied Cervix", "correct": false}], "correct_answer": "A. Myxomatous Polyp", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Myxomatous P\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the labeling correctly:", "options": [{"label": "A", "text": "A- Superior vena cava, B- Ascending aorta, C- Pulmonary trunk, D- Descending aorta", "correct": true}, {"label": "B", "text": "A- Ascending aorta, B- Descending aorta, C- Pulmonary trunk, D- Superior vena cava", "correct": false}, {"label": "C", "text": "A- Ascending aorta, B- Superior vena cava, C- Descending aorta, D- Pulmonary trunk,", "correct": false}, {"label": "D", "text": "A- Ascending aorta, B- Superior Vena Cava, C- Pulmonary trunk, D- Descending aorta", "correct": false}], "correct_answer": "A. A- Superior vena cava, B- Ascending aorta, C- Pulmonary trunk, D- Descending aorta", "question_images": ["https://image.prepladder.com/content/xKDLNLWpZbpRp7YdTh8N1727075048.png"], "explanation_images": ["https://image.prepladder.com/content/jXmxdHXIIRgsTwo5e9Bx1727075428.jpg"], "explanation": "<p>Correct Option A - A- , B-Ascending &lt;span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\"&gt;aorta&lt;/span&gt; , C- &lt;span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\"&gt;Pulmonary&lt;/span&gt; trunk, D- &lt;span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\"&gt;Descending&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the management of Squamous Cell Carcinoma (SCC) of the lip, which biopsy technique is most appropriate to obtain a representative sample of the tumor?", "options": [{"label": "A", "text": "Incisional Biopsy", "correct": true}, {"label": "B", "text": "Excisional Biopsy", "correct": false}, {"label": "C", "text": "Superficial Biopsy from the Border with Normal Tissue", "correct": false}, {"label": "D", "text": "Contraindicated", "correct": false}], "correct_answer": "A. Incisional Biopsy", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Incisional B\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with loss of sensation on lateral 3 1 / 2 hand and thenar atrophy. Which nerve is involved?", "options": [{"label": "A", "text": "Median", "correct": true}, {"label": "B", "text": "Ulnar", "correct": false}, {"label": "C", "text": "Radial", "correct": false}, {"label": "D", "text": "Anterior interosseous nerve", "correct": false}], "correct_answer": "A. Median", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/vw2h1kwYR18cs1NvGVrX1747657121.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Motor Dysfunction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sensory Dysfunction</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Common Deformity/Condition</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Median Nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weakness of <span class=\"customMeta\" data-dictid=\"48c587f4c51692777200fe869f1699\">thenar</span> muscles (thumb opposition), <strong>flexor muscles</strong> of forearm</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Loss of sensation in <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> 3.5 fingers (thumb, index, middle, half of the ring finger)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ape hand</strong> (thenar atrophy), <strong>Carpal tunnel syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Ulnar Nerve </strong><strong>(Option B ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weakness of <span class=\"customMeta\" data-dictid=\"a6795c876e169277719057a1099465\">intrinsic</span> hand muscles (especially interossei), <strong>hypothenar muscles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Loss of sensation in <span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\">medial</span> 1.5 fingers (little and half of the ring finger)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Claw hand</strong>, <strong>Hypothenar atrophy</strong>, <strong>Cubital tunnel syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Radial Nerve </strong><strong>(Option C ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inability to extend wrist and fingers (wrist drop)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Loss of sensation over the <span class=\"customMeta\" data-dictid=\"f61866c72d169277718680f9c96ff2\">dorsum</span> of the hand</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Wrist drop</strong>, <strong>Saturday night palsy</strong>, <strong>Radial tunnel syndrome</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Anterior Interosseous Nerve (AIN) </strong><strong>(Option D ruled out)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Inability to <span class=\"customMeta\" data-dictid=\"73eb6a06aa1692777202a9f27fafa2\">flex</span> thumb and <span class=\"customMeta\" data-dictid=\"6ee643d13c1692777190386314a416\">index finger</span> (loss of <span class=\"customMeta\" data-dictid=\"85ff8a7ff81692777202a827961a5c\">flexion</span> of <span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\">distal</span> phalanges)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> loss (pure motor neuropathy)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Inability to make \"OK\" sign</strong> (difficulty flexing thumb and index finger)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Long Thoracic Nerve</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Weakness of <span class=\"customMeta\" data-dictid=\"2462a1d0cf16927771985f03ba098b\">serratus</span> <span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\">anterior</span> muscle, affecting scapular movement</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>No <span class=\"customMeta\" data-dictid=\"408bcde7f01692777198acadb8e1c6\">sensory</span> loss</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Winged scapula</strong> (scapula protrudes from the back)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented to the OPD with hepatosplenomegaly, and his bone marrow showed 22% of plasma cells. Biopsy reveals pinkish acellular material deposition. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Myxoid degeneration of the bone marrow", "correct": false}, {"label": "B", "text": "Amyloidosis", "correct": true}, {"label": "C", "text": "Plasma cell leukemia", "correct": false}, {"label": "D", "text": "Hemolytic anemia", "correct": false}], "correct_answer": "B. Amyloidosis", "question_images": ["https://image.prepladder.com/content/a0u9AFSmQTVQ6ofgsnfW1724851643.png"], "explanation_images": ["https://image.prepladder.com/content/fFpXRMfDEutvwEr1IrAb1724852174.png"], "explanation": "<p>Correct Option B – A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Using the radiograph provided, which diagnosis is most likely?", "options": [{"label": "A", "text": "Chiari type 1 malformation", "correct": true}, {"label": "B", "text": "Dandy-Walker malformation", "correct": false}, {"label": "C", "text": "Vein of Galen malformation", "correct": false}, {"label": "D", "text": "Corpus callosum agenesis", "correct": false}], "correct_answer": "A. Chiari type 1 malformation", "question_images": ["https://image.prepladder.com/content/TNsKTBFkGAlSLbdIaEsg1724751751.png"], "explanation_images": ["https://image.prepladder.com/content/NTaOYnjxlbzbz1nVpCXn1724751865.png"], "explanation": "<p>Correct Option A - Chiari &lt;span class=\"customMeta\" data-dictid=\"ebcb7136251692777201ef4b5c5718\"&gt;type 1&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What investigation is being performed in the image below?", "options": [{"label": "A", "text": "Fluoroscopy", "correct": false}, {"label": "B", "text": "Barium swallow", "correct": true}, {"label": "C", "text": "X-ray for alkali ingestion", "correct": false}, {"label": "D", "text": "X-ray for acid ingestion", "correct": false}], "correct_answer": "B. Barium swallow", "question_images": ["https://image.prepladder.com/content/wn5pjYf7G7fETPRSCd551724752809.png"], "explanation_images": ["https://image.prepladder.com/content/ya2XSFgtrujoFi6dokqH1724849352.png"], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"55052c0f0616927771829c99eec183\"&gt;Barium&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A pregnant woman with a known case of asthma presents with postpartum hemorrhage (PPH). Which drug is contraindicated?", "options": [{"label": "A", "text": "Methyl ergometrine", "correct": false}, {"label": "B", "text": "Carboprost", "correct": true}, {"label": "C", "text": "Misoprostol", "correct": false}, {"label": "D", "text": "Oxytocin", "correct": false}], "correct_answer": "B. Carboprost", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - C\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient diagnosed with sciatica had tender hamstrings. Which of the following supplies a hybrid muscle, which is spared in this patient?", "options": [{"label": "A", "text": "Femoral nerve", "correct": false}, {"label": "B", "text": "Common peroneal nerve", "correct": false}, {"label": "C", "text": "Obturator nerve", "correct": true}, {"label": "D", "text": "Tibial nerve", "correct": false}], "correct_answer": "C. Obturator nerve", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A regular contact lens user presents with corneal ulcers and diminished vision. He was very careless about his lens fluid. On microscopy, an organism with spikes is identified. What is the causative organism?", "options": [{"label": "A", "text": "Acanthamoeba", "correct": true}, {"label": "B", "text": "Naegleria", "correct": false}, {"label": "C", "text": "Balamuthia", "correct": false}, {"label": "D", "text": "Giardia lamblia", "correct": false}], "correct_answer": "A. Acanthamoeba", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Acanth\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old female presented with back pain for six months. Her CT scan image is given below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Paget's disease", "correct": false}, {"label": "B", "text": "Osteoporosis", "correct": false}, {"label": "C", "text": "Spondylolisthesis", "correct": true}, {"label": "D", "text": "Renal osteodystrophy", "correct": false}], "correct_answer": "C. Spondylolisthesis", "question_images": ["https://image.prepladder.com/content/lI6s2wRNZjFugN1Gr1g21724908916.png"], "explanation_images": ["https://image.prepladder.com/content/8dNkj3CqqfxY2qJ3iKMV1724838478.png"], "explanation": "<p>Correct Option C – Spondylolisth\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A physician is evaluating a patient for an occupational disease and finds that a coproporphyrin test has been performed. Which of the following conditions is most likely suspected?", "options": [{"label": "A", "text": "Lead poisoning", "correct": true}, {"label": "B", "text": "Berylliosis", "correct": false}, {"label": "C", "text": "Silicosis", "correct": false}, {"label": "D", "text": "Asbestosis", "correct": false}], "correct_answer": "A. Lead poisoning", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td><strong>Diagnostic Test</strong></td>\n<td>Urine <span class=\"customMeta\" data-dictid=\"0a74553845169277718571f94964fb\">coproporphyrin</span> levels</td>\n</tr>\n<tr>\n<td><strong>Pathophysiology</strong></td>\n<td>Lead inhibits <span class=\"customMeta\" data-dictid=\"d4fff554a316927771885dc8700abe\">heme</span> synthesis, causing accumulation of porphyrins</td>\n</tr>\n<tr>\n<td><strong>Symptoms</strong></td>\n<td>Neurological symptoms, <span class=\"customMeta\" data-dictid=\"1665a40f1016927771801899eaed5d\">abdominal</span> pain, anemia, <span class=\"customMeta\" data-dictid=\"255674f3271692777195c172d86daf\">peripheral</span> neuropathy</td>\n</tr>\n<tr>\n<td><strong>Other <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">Diagnostic</span> Methods</strong></td>\n<td>Blood lead levels, <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> <span class=\"customMeta\" data-dictid=\"da0e2a00fa1692777202d6e2054b26\">fluorescence</span> analysis</td>\n</tr>\n<tr>\n<td><strong>Management</strong></td>\n<td>Chelation therapy (e.g., EDTA, DMSA)</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old patient presented with acute epigastric pain and elevated serum lipase. He was stabilized after three days. What is the most common pathology associated with the chest X-ray obtained?", "options": [{"label": "A", "text": "Acute Respiratory Distress Syndrome (ARDS)", "correct": true}, {"label": "B", "text": "Acute pulmonary edema", "correct": false}, {"label": "C", "text": "Pulmonary thromboembolism", "correct": false}, {"label": "D", "text": "Miliary tuberculosis (TB)", "correct": false}], "correct_answer": "A. Acute Respiratory Distress Syndrome (ARDS)", "question_images": ["https://image.prepladder.com/content/95oa6dPY60zk2NoTBLNY1724752043.png"], "explanation_images": [], "explanation": "<table>\n<thead>\n<tr>\n<th>Condition</th>\n<th>Primary Event</th>\n<th>Lung Complication</th>\n<th>Time of Onset</th>\n<th>Imaging Finding</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>Acute pancreatitis</td>\n<td>Inflammation, <span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\">enzyme</span> release</td>\n<td>ARDS</td>\n<td>Within 24–72 hours</td>\n<td>Bilateral infiltrates (non-cardiogenic)</td>\n</tr>\n<tr>\n<td>Heart failure</td>\n<td>Volume overload</td>\n<td>Pulmonary edema</td>\n<td>Variable</td>\n<td>Bilateral <span class=\"customMeta\" data-dictid=\"b78b1bdf6c1692777195170be3d18f\">perihilar</span> haziness + cardiomegaly</td>\n</tr>\n<tr>\n<td>Pulmonary embolism</td>\n<td>Thrombus in <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> arteries</td>\n<td>Infarcts, pleural-based opacities</td>\n<td>Sudden onset</td>\n<td>Wedge-shaped infarcts on CXR/CT</td>\n</tr>\n<tr>\n<td>Miliary TB</td>\n<td>Disseminated TB infection</td>\n<td>Miliary nodules throughout lung</td>\n<td>Subacute/chronic</td>\n<td>Uniform millet-sized nodules</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the health education model, the first step is awareness; the second step is motivation. What is the third step?", "options": [{"label": "A", "text": "Reflection", "correct": false}, {"label": "B", "text": "Dedication", "correct": false}, {"label": "C", "text": "Contemplation", "correct": false}, {"label": "D", "text": "Action", "correct": true}], "correct_answer": "D. Action", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/44weURLqYQ0CZSySKpVs1724851376.png", "https://image.prepladder.com/content/9RLU4JvDVx69CXNROWdK1724851390.png"], "explanation": "<p>Correct Option D - A\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A woman presents with a twin pregnancy. On ultrasound, the estimated age of one fetus is 1 month more than the other fetus. What is the diagnosis?", "options": [{"label": "A", "text": "Superfetation", "correct": true}, {"label": "B", "text": "Superfecundation", "correct": false}, {"label": "C", "text": "Suppositious child", "correct": false}, {"label": "D", "text": "Posthumous child", "correct": false}], "correct_answer": "A. Superfetation", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A – Su\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the markers in the given slide:", "options": [{"label": "A", "text": "A- Eccrine sweat gland, B- Arrector pilorum, C- Sebaceous gland, D- Apocrine gland", "correct": true}, {"label": "B", "text": "A- Arrector pilorum, B- Eccrine sweat gland, C- Sebaceous gland, D- Apocrine gland", "correct": false}, {"label": "C", "text": "A- Eccrine sweat gland, B- Arrector pilorum, C- Apocrine gland, D-Sebaceous gland", "correct": false}, {"label": "D", "text": "A- Sebaceous gland, B- Apocrine gland, C- Eccrine sweat gland, D- Arrector pilorum", "correct": false}], "correct_answer": "A. A- Eccrine sweat gland, B- Arrector pilorum, C- Sebaceous gland, D- Apocrine gland", "question_images": ["https://image.prepladder.com/content/IVDg18Csula66uls0HAo1724927745.png"], "explanation_images": ["https://image.prepladder.com/content/kal9lkmrv5Bn74R8NVnd1727179856.jpg", "https://image.prepladder.com/content/G07kBgT6anWFpfoPhQet1727178492.jpg"], "explanation": "<p>Correct Option A - A- &lt;span class=\"customMeta\" data-dictid=\"e626f316ac1692777186d52f1ab7e6\"&gt;Eccrine&lt;/span&gt; sweat gland, B- &lt;span class=\"customMeta\" data-dictid=\"5ff1eff91d169277718206eea7060c\"&gt;Arrector&lt;/span&gt; pilorum, C- &lt;span class=\"customMeta\" data-dictid=\"359edf0778169277719886070af9db\"&gt;Sebaceous&lt;/span&gt; gland, D- &lt;span class=\"customMeta\" data-dictid=\"495f6155fb1692777181ce9121d548\"&gt;Apocrine&lt;/span&gt; g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A hypertensive patient stopped antihypertensive medication due to dry eyes, dry mouth and constipation. After stopping the drug, he developed hypertensive emergency (BP &amp;gt; 180/120). Most likely drug is:", "options": [{"label": "A", "text": "Clonidine", "correct": true}, {"label": "B", "text": "Lisinopril", "correct": false}, {"label": "C", "text": "Amlodipine", "correct": false}, {"label": "D", "text": "Telmisartan", "correct": false}], "correct_answer": "A. Clonidine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - C\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient suffers an inversion injury to the ankle. Which structure is most likely to get injured?", "options": [{"label": "A", "text": "Tibialis anterior tendon", "correct": false}, {"label": "B", "text": "Tibialis posterior tendon", "correct": false}, {"label": "C", "text": "Extensor hallucis longus tendon", "correct": false}, {"label": "D", "text": "Anterior talofibular ligament", "correct": true}], "correct_answer": "D. Anterior talofibular ligament", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\"&gt;Anterior&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"02a8b612541692777200b54f68e5f6\"&gt;talofibular&lt;/span&gt; lig\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is seen in the given image?", "options": [{"label": "A", "text": "Horner trantas spots", "correct": false}, {"label": "B", "text": "Herbert pits", "correct": true}, {"label": "C", "text": "Pannus", "correct": false}, {"label": "D", "text": "Corneal dystrophy", "correct": false}], "correct_answer": "B. Herbert pits", "question_images": ["https://image.prepladder.com/content/Dcs1IbvB8kQYWJ3Pf70X1724830816.png"], "explanation_images": ["https://image.prepladder.com/content/Tg7raRr37edSu1rco9p51724830828.png", "https://image.prepladder.com/content/8qFHp15NzlMbWM4L5rhw1724830896.png", "https://image.prepladder.com/content/8saaQjYxYivx223krD4P1724830941.png", "https://image.prepladder.com/content/QtKtHwDNvmh5DBuUJqL71724830974.png", "https://image.prepladder.com/content/t8X68ecPK4j0iWKg1EdQ1724831027.png"], "explanation": "<p>Correct Option B - H\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient who has undergone gastrectomy (surgical removal of part or all of the stomach) is at risk of deficiencies in certain nutrients. Which of the following vitamins is most likely to require supplementation in such a patient?", "options": [{"label": "A", "text": "Vitamin C", "correct": false}, {"label": "B", "text": "Vitamin D", "correct": false}, {"label": "C", "text": "Vitamin B12", "correct": true}, {"label": "D", "text": "Vitamin A", "correct": false}], "correct_answer": "C. Vitamin B12", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Vitamin B12\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which type of ulcer is given below?", "options": [{"label": "A", "text": "Venous ulcer", "correct": true}, {"label": "B", "text": "Arterial ulcer", "correct": false}, {"label": "C", "text": "Trophic ulcer", "correct": false}, {"label": "D", "text": "Diabetic foot", "correct": false}], "correct_answer": "A. Venous ulcer", "question_images": ["https://image.prepladder.com/content/nE6MUsYhgKh18ApjN4CP1724915971.png"], "explanation_images": ["https://image.prepladder.com/content/gM6Ebpp1mLmoh8dLr8Pj1724915995.png"], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"96e7e3fecc16927772018cb9f8c8cd\"&gt;Venous&lt;/span&gt; u\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with headaches, palpitations, and hypertension. On laboratory examination, urine VMA is positive. His biopsy findings are given below. Which of the following is a correct statement?", "options": [{"label": "A", "text": "Mostly malignant", "correct": false}, {"label": "B", "text": "Mostly in children", "correct": false}, {"label": "C", "text": "Mostly bilateral", "correct": false}, {"label": "D", "text": "Associated with MEN2A", "correct": true}], "correct_answer": "D. Associated with MEN2A", "question_images": ["https://image.prepladder.com/content/7HAe7cyzygGAEYUUFyBi1724852454.png"], "explanation_images": [], "explanation": "<p>Correct Option D - Associated with MEN2A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which visual field defect is likely to be caused by the lesion shown in the given radiograph?", "options": [{"label": "A", "text": "Altitudinal defect", "correct": false}, {"label": "B", "text": "Bitemporal hemianopia", "correct": true}, {"label": "C", "text": "Inferior arcuate scotoma", "correct": false}, {"label": "D", "text": "Bjerrum scotoma", "correct": false}], "correct_answer": "B. Bitemporal hemianopia", "question_images": ["https://image.prepladder.com/content/wyEYfh40UpFhqODrQ6fj1724912891.png"], "explanation_images": ["https://image.prepladder.com/content/VxYVGqQpQoKW1QftBZ7D1724929441.JPG"], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"3b17da47ce16927771831d5dde3af3\"&gt;Bitemporal&lt;/span&gt; h\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An adult tall male presents with subluxation of the lens, long arm span, pectus excavatum, and cardiac abnormalities. What is the most likely protein found to be defective?", "options": [{"label": "A", "text": "Elastin", "correct": false}, {"label": "B", "text": "Collagen", "correct": false}, {"label": "C", "text": "Fibrillin", "correct": true}, {"label": "D", "text": "Laminin", "correct": false}], "correct_answer": "C. Fibrillin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C – F\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/anPiVDuQ1YS41askCVHj1748421024.mp3", "video": ""}, {"text": "In which phase of clinical trials drug dosing is determined?", "options": [{"label": "A", "text": "Phase 1", "correct": true}, {"label": "B", "text": "Phase 2", "correct": false}, {"label": "C", "text": "Phase 3", "correct": false}, {"label": "D", "text": "Phase 4", "correct": false}], "correct_answer": "A. Phase 1", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/2pXhOXYe8fE3jft9wiVq1724851258.png"], "explanation": "<p>Correct Option A - Ph\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/HGdY7nISDG9CHiULqqJO1746262864.mp3", "video": ""}, {"text": "Whose opinion is not needed for Medical Termination of Pregnancy (MTP) after 24 weeks due to fetal anomalies?", "options": [{"label": "A", "text": "Gynaecologist", "correct": false}, {"label": "B", "text": "Radiologist", "correct": false}, {"label": "C", "text": "Pediatrician", "correct": false}, {"label": "D", "text": "Lawyer", "correct": true}], "correct_answer": "D. Lawyer", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child presents with itchy lesions and diarrhea and has been advised to follow a gluten-free diet. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Celiac disease", "correct": true}, {"label": "B", "text": "Whipple's disease", "correct": false}, {"label": "C", "text": "Crohn's disease", "correct": false}, {"label": "D", "text": "Ulcerative colitis", "correct": false}], "correct_answer": "A. Celiac disease", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Ptosis in horner’s syndrome is due to paralysis of which muscle?", "options": [{"label": "A", "text": "Superior tarsal muscle", "correct": true}, {"label": "B", "text": "Orbitalis", "correct": false}, {"label": "C", "text": "Orbicularis oculi", "correct": false}, {"label": "D", "text": "Sphincter pupillae", "correct": false}], "correct_answer": "A. Superior tarsal muscle", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Superior &lt;span class=\"customMeta\" data-dictid=\"b07a8f84ed1692777200d49cca6177\"&gt;Tarsal&lt;/span&gt; Muscle (Müller's Muscle)\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Shanchol vaccine consists of?", "options": [{"label": "A", "text": "Monovalent 2 doses", "correct": false}, {"label": "B", "text": "Monovalent 1 dose", "correct": false}, {"label": "C", "text": "Bivalent 2 doses", "correct": true}, {"label": "D", "text": "Bivalent 1 dose", "correct": false}], "correct_answer": "C. Bivalent 2 doses", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"72e40ae28916927771833a7a1d469b\"&gt;Bivalent&lt;/span&gt; 2\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with shortness of breath. Vitals are HR= 120/min, BP= 160/100. Echo shows diastolic collapse of ventricles. CT showed money bag appearance. Which is best for management of this patient?", "options": [{"label": "A", "text": "Start diuretic with BP monitoring", "correct": false}, {"label": "B", "text": "Intra aortic balloon pump", "correct": false}, {"label": "C", "text": "Pericardiocentesis", "correct": true}, {"label": "D", "text": "Ventricular assist device", "correct": false}], "correct_answer": "C. Pericardiocentesis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - P\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An HIV-positive patient with a history of gastrointestinal helminth infection has a stool sample showing motile 200-micron larvae but no eggs. Identify the parasite:", "options": [{"label": "A", "text": "Ascaris", "correct": false}, {"label": "B", "text": "Strongyloides", "correct": true}, {"label": "C", "text": "Ancylostoma", "correct": false}, {"label": "D", "text": "Schistostoma", "correct": false}], "correct_answer": "B. Strongyloides", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/dqYByCw8Xi2VbXk40SgP1724837545.png"], "explanation": "<p>Correct Option B - Strong\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female patient’s Pure Tone Audiometry (PTA) findings reveal a Carhart's notch. Which of the following is most likely associated with this finding?", "options": [{"label": "A", "text": "Schwartz sign", "correct": true}, {"label": "B", "text": "Hitzelberger sign", "correct": false}, {"label": "C", "text": "Henebert sign", "correct": false}, {"label": "D", "text": "Aquinos Sign", "correct": false}], "correct_answer": "A. Schwartz sign", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/GWdP1IxrvBX7qb87Vuip1724839388.png"], "explanation": "<p>Correct Option A - Schwartz sig\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the degree of uterine prolapse.", "options": [{"label": "A", "text": "Degree 1", "correct": false}, {"label": "B", "text": "Degree 2", "correct": false}, {"label": "C", "text": "Degree 3", "correct": true}, {"label": "D", "text": "Degree 4", "correct": false}], "correct_answer": "C. Degree 3", "question_images": ["https://image.prepladder.com/content/nvPicQ6XKD4QAgVPW7Vx1724825273.png"], "explanation_images": [], "explanation": "<p>Correct Option C - Degree 3\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 2-year-old child presents with a focal area of hair loss accompanied by scaling and itching, as shown in the image. The child’s sibling had a similar condition two years ago. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Tinea", "correct": true}, {"label": "B", "text": "Alopecia areata", "correct": false}, {"label": "C", "text": "Pyoderma", "correct": false}, {"label": "D", "text": "Pediculosis capitis", "correct": false}], "correct_answer": "A. Tinea", "question_images": ["https://image.prepladder.com/content/DegEPx668JuNn3yQ5EWz1724754626.png"], "explanation_images": [], "explanation": "<p>Correct Option A - T\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Example of SNRI antidepressant drug", "options": [{"label": "A", "text": "Reboxatine", "correct": true}, {"label": "B", "text": "Tramadol", "correct": false}, {"label": "C", "text": "Paroxetine", "correct": false}, {"label": "D", "text": "Bupropion", "correct": false}], "correct_answer": "A. Reboxatine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - R\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is a complication of Total Parenteral Nutrition (TPN) in a sepsis patient in the ICU?", "options": [{"label": "A", "text": "Hyperlipidemia", "correct": false}, {"label": "B", "text": "Hyperglycemia", "correct": true}, {"label": "C", "text": "Hyperglyceridemia", "correct": false}, {"label": "D", "text": "Hypoglycemia", "correct": false}], "correct_answer": "B. Hyperglycemia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Hyperg\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Sequence the events in neuromuscular action potential conduction: Sodium channels open in the end plate Calcium enters at the nerve end plate Release of acetylcholine", "options": [{"label": "A", "text": "1 → 2 → 3", "correct": false}, {"label": "B", "text": "1 → 3 → 2", "correct": false}, {"label": "C", "text": "3 → 2 → 1", "correct": false}, {"label": "D", "text": "2 → 3 → 1", "correct": true}], "correct_answer": "D. 2 → 3 → 1", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - 2 → 3 →\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old woman has consulted several plastic surgeons, seeking correction for a facial deformity that she perceives. Despite being examined and reassured by the surgeons and her family that no deformity is present, she remains convinced that her face requires surgery. She frequently checks her appearance and persists in requesting surgical intervention. What is the most appropriate management for her condition?", "options": [{"label": "A", "text": "SSRI", "correct": true}, {"label": "B", "text": "Atypical antipsychotic", "correct": false}, {"label": "C", "text": "Insight therapy", "correct": false}, {"label": "D", "text": "SNRI", "correct": false}], "correct_answer": "A. SSRI", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A – SSRI\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents to the OPD as a known case of cervical cancer. On further evaluation, the pelvic sidewall was found to be involved, and hydronephrosis was also seen. Identify the stage of cancer.", "options": [{"label": "A", "text": "Stage 2B", "correct": false}, {"label": "B", "text": "Stage 2A", "correct": false}, {"label": "C", "text": "Stage 3B", "correct": true}, {"label": "D", "text": "Stage 3A", "correct": false}], "correct_answer": "C. Stage 3B", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/7bNQpZvRCKxOApMu2Rkj1724829467.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with sudden diminution of vision, difficulty looking towards the light, and circumcorneal congestion with a hypopyon. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Acute conjunctivitis", "correct": false}, {"label": "B", "text": "Acute angle closure glaucoma", "correct": false}, {"label": "C", "text": "Episcleritis", "correct": false}, {"label": "D", "text": "Acute anterior uveitis", "correct": true}], "correct_answer": "D. Acute anterior uveitis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\"&gt;Acute&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\"&gt;anterior&lt;/span&gt; uv\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "How is transferrin saturation affected by iron deficiency anemia?", "options": [{"label": "A", "text": "Increased", "correct": false}, {"label": "B", "text": "Decreased", "correct": true}, {"label": "C", "text": "Normal", "correct": false}, {"label": "D", "text": "Dynamic", "correct": false}], "correct_answer": "B. Decreased", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B – D\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A pregnant woman presents with an intrauterine device (IUD) in place, and the thread is clearly visible. The woman wants to keep the pregnancy. What should be done next?", "options": [{"label": "A", "text": "Leave IUD inside", "correct": false}, {"label": "B", "text": "Remove gently", "correct": true}, {"label": "C", "text": "MTP (Medical Termination of Pregnancy)", "correct": false}, {"label": "D", "text": "Cesarean section", "correct": false}], "correct_answer": "B. Remove gently", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Remove g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following diseases follows the mode of inheritance shown in the image provided?", "options": [{"label": "A", "text": "Wiskott-Aldrich syndrome", "correct": true}, {"label": "B", "text": "Wilson's disease", "correct": false}, {"label": "C", "text": "Prader-Willi syndrome", "correct": false}, {"label": "D", "text": "Achondroplasia", "correct": false}], "correct_answer": "A. Wiskott-Aldrich syndrome", "question_images": ["https://image.prepladder.com/content/yHbSs9UZqPVeUCg6cxpV1724850901.png"], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/dmqAQJMoF8TC33GkHsy61748420906.mp3", "video": ""}, {"text": "In sacrocolpopexy (Sacrocolposuspension), the surgical mesh is attached to which bony landmark?", "options": [{"label": "A", "text": "Sacral promontory", "correct": true}, {"label": "B", "text": "Ischial spine", "correct": false}, {"label": "C", "text": "Pubic symphysis", "correct": false}, {"label": "D", "text": "Ischial tuberosity", "correct": false}], "correct_answer": "A. Sacral promontory", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - S\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "When do you put a victim in the following position?", "options": [{"label": "A", "text": "Conscious patient with pulse &amp;amp; breathing present.", "correct": false}, {"label": "B", "text": "Unconscious patient with pulse &amp;amp; breathing present.", "correct": true}, {"label": "C", "text": "Unconscious patient with pulse present but no breathing.", "correct": false}, {"label": "D", "text": "Unconscious patient without pulse but breathing present.", "correct": false}], "correct_answer": "B. Unconscious patient with pulse &amp; breathing present.", "question_images": ["https://image.prepladder.com/content/OrU3ECBoslCDgoMs8c1V1724929545.JPG"], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"6d87fbc02c16927772014ec4cead53\"&gt;Unconscious&lt;/span&gt; patient with pulse and breathing present</p>\n<table>\n<thead>\n<tr>\n<th>Patient Status</th>\n<th>Recovery Position Used?</th>\n<th>Reason</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>Conscious with pulse &amp; breathing (Option A)</td>\n<td>No</td>\n<td>No need to alter position unless needed for comfort or other reasons.</td>\n</tr>\n<tr>\n<td><strong>Unconscious with pulse &amp; breathing (Option B)</strong></td>\n<td><strong>Yes</strong></td>\n<td>Prevents <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> <span class=\"customMeta\" data-dictid=\"39f44b27bf169277719416f29a74ee\">obstruction</span> and aspiration.</td>\n</tr>\n<tr>\n<td>Unconscious with pulse but no breathing (Option C)</td>\n<td>No</td>\n<td>Requires <strong>rescue breathing or CPR</strong>, not recovery position.</td>\n</tr>\n<tr>\n<td>Unconscious without pulse but breathing (Option D)</td>\n<td>No</td>\n<td>This is physiologically unlikely; no pulse = no circulation.</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female presented with 1x 1 cm thyroid swelling. What is next best step in management?", "options": [{"label": "A", "text": "I 131", "correct": false}, {"label": "B", "text": "TSH", "correct": false}, {"label": "C", "text": "TSH and T4", "correct": true}, {"label": "D", "text": "T3 and T4", "correct": false}], "correct_answer": "C. TSH and T4", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - TSH and T4\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Calculate the maternal mortality ratio (MMR) for the year 2023, given the following events: Total women who died: 6 Total live births: 4000 Causes of death: 1 due to road traffic accident (RTA) 1 due to sepsis 1 due to obstructed labor 1 due to eclampsia 1 due to ectopic pregnancy 1 due to snake bite", "options": [{"label": "A", "text": "75", "correct": false}, {"label": "B", "text": "150", "correct": false}, {"label": "C", "text": "100", "correct": true}, {"label": "D", "text": "125", "correct": false}], "correct_answer": "C. 100", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/KQZXozMX6xcsH0yPiDNz1724761497.png", "https://image.prepladder.com/content/DFT5z5jDfsSYzAnoUdaS1724850628.png"], "explanation": "<p>Correct Option C\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient has pleural fluid with an LDH level greater than 0.6 times the serum LDH and protein greater than 0.5 times the serum protein. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Tuberculosis (TB)", "correct": true}, {"label": "B", "text": "Heart failure", "correct": false}, {"label": "C", "text": "Hepatic failure", "correct": false}, {"label": "D", "text": "Renal failure", "correct": false}], "correct_answer": "A. Tuberculosis (TB)", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"8d98ce2d3616927772013bfc3e0528\"&gt;Tuberculosis&lt;/span&gt; (TB)\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Tuberculosis (TB)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Key Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Exudative pleural <span class=\"customMeta\" data-dictid=\"73909075e71692777187f08d3c9b7e\">effusion</span> with high protein and <span class=\"customMeta\" data-dictid=\"511c533d8b1692777191aa64479963\">LDH</span> levels</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnostic Criteria</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Light's criteria: Pleural fluid protein &gt; 0.5 times <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> protein, <span class=\"customMeta\" data-dictid=\"511c533d8b1692777191aa64479963\">LDH</span> &gt; 0.6 times <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> LDH</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Differential Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Excludes heart failure, <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> failure, and <span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\">renal</span> failure due to their association with transudative effusions</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Rationale</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>TB is a common cause of <span class=\"customMeta\" data-dictid=\"8388ec88871692777187acdf19cc80\">exudative</span> effusion, fitting the pleural fluid analysis described</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements regarding von Willebrand disease is incorrect?", "options": [{"label": "A", "text": "Type 2 von Willebrand disease is associated with a moderate bleeding tendency", "correct": false}, {"label": "B", "text": "Type 3 von Willebrand disease is associated with a complete absence of factor VIII", "correct": false}, {"label": "C", "text": "Type 1 von Willebrand disease presents with severe bleeding since childhood", "correct": true}, {"label": "D", "text": "Type 2 von Willebrand disease includes subtypes with varying defects in von Willebrand factor.", "correct": false}], "correct_answer": "C. Type 1 von Willebrand disease presents with severe bleeding since childhood", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"ebcb7136251692777201ef4b5c5718\"&gt;Type 1&lt;/span&gt; von Willebrand disease presents with severe &lt;span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\"&gt;bleeding&lt;/span&gt; since childh\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Type 1 von Willebrand Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Mild <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> tendency; partial <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> of von Willebrand factor</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type 2 von Willebrand Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Moderate <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> tendency; includes subtypes with varying defects in von Willebrand factor</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Type 3 von Willebrand Disease</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Severe <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> tendency; severe <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> or absence of von Willebrand factor, leading to very low <span class=\"customMeta\" data-dictid=\"65dc2273b5169277720208ba704b7f\">factor VIII</span> levels</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is responsible for the transport of iodine into the thyroid follicle?", "options": [{"label": "A", "text": "Na/I symporter", "correct": true}, {"label": "B", "text": "Pendrin", "correct": false}, {"label": "C", "text": "Cl/I symporter", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "A. Na/I symporter", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Na/I\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which receptor helps in the improvement of insulin resistance in Type 2 Diabetes Mellitus (DM2) with regular exercise and physical activities?", "options": [{"label": "A", "text": "GLUT 1", "correct": false}, {"label": "B", "text": "GLUT 2", "correct": false}, {"label": "C", "text": "GLUT 3", "correct": false}, {"label": "D", "text": "GLUT 4", "correct": true}], "correct_answer": "D. GLUT 4", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the given fracture:", "options": [{"label": "A", "text": "Burst fracture", "correct": false}, {"label": "B", "text": "Compression fracture", "correct": false}, {"label": "C", "text": "Chance fracture", "correct": true}, {"label": "D", "text": "Impacted fracture", "correct": false}], "correct_answer": "C. Chance fracture", "question_images": ["https://image.prepladder.com/content/mQNAkGQLCZpyF9k6ny6E1724749423.png"], "explanation_images": [], "explanation": "<p>Correct Option C – Chance fractu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient complains of eye pain and difficulty seeing after watching a movie. What is the first step in management?", "options": [{"label": "A", "text": "Mannitol with moxifloxacin", "correct": false}, {"label": "B", "text": "Mannitol with pilocarpine", "correct": true}, {"label": "C", "text": "Mannitol with atropine", "correct": false}, {"label": "D", "text": "Mannitol with carboxymethylcellulose", "correct": false}], "correct_answer": "B. Mannitol with pilocarpine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"67ba030b801692777191d63dce44b4\"&gt;Mannitol&lt;/span&gt; with\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the typical pressure setting for the valve in a Mapleson circuit?", "options": [{"label": "A", "text": "30–40 cm H₂O,", "correct": true}, {"label": "B", "text": "30–40 mm Hg", "correct": false}, {"label": "C", "text": "10–20 cm H₂O", "correct": false}, {"label": "D", "text": "10–20 mm Hg", "correct": false}], "correct_answer": "A. 30–40 cm H₂O,", "question_images": [], "explanation_images": [], "explanation": "<table>\n<thead>\n<tr>\n<th>Feature</th>\n<th>Details</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>Used in</td>\n<td>Anesthesia, manual or controlled ventilation</td>\n</tr>\n<tr>\n<td>APL <span class=\"customMeta\" data-dictid=\"416dd1004a169277720177d9a6adc5\">Valve</span> Purpose</td>\n<td>Limits peak <span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\">airway</span> pressure by releasing <span class=\"customMeta\" data-dictid=\"7a1ae24f701692777187a7f60bbd9f\">excess</span> gas</td>\n</tr>\n<tr>\n<td>Valve Pressure Setting</td>\n<td><strong>Typically 30–40 cm H₂O</strong>, especially during controlled ventilation</td>\n</tr>\n<tr>\n<td>Spontaneous <span class=\"customMeta\" data-dictid=\"a58f1f33f81692777201ad5e0d60ca\">Ventilation</span> Use</td>\n<td>Valve kept open to atmosphere (minimal resistance)</td>\n</tr>\n<tr>\n<td>Risk if too high</td>\n<td>&gt;40 cm H₂O may cause barotrauma</td>\n</tr>\n<tr>\n<td>Units Used</td>\n<td><strong>cm H₂O</strong> (not mm Hg) in <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> and <span class=\"customMeta\" data-dictid=\"e24b7bd55d16927771818aaa6ad0ed\">anesthesia</span> circuits</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What condition is indicated by the MRCP image below?", "options": [{"label": "A", "text": "Choledochal cyst", "correct": true}, {"label": "B", "text": "Cholangiocarcinoma", "correct": false}, {"label": "C", "text": "Cholelithiasis", "correct": false}, {"label": "D", "text": "Choledocholithiasis", "correct": false}], "correct_answer": "A. Choledochal cyst", "question_images": ["https://image.prepladder.com/content/B5hC2W5438OaEnLwMInS1724912692.png"], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"dab15cbc3a1692777184db8eae94c4\"&gt;Choledochal&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child with untreated ADHD is most likely to develop which of the following disorders during adolescence?", "options": [{"label": "A", "text": "Binge eating", "correct": false}, {"label": "B", "text": "Selective mutism", "correct": false}, {"label": "C", "text": "Separation from parent leading to depression", "correct": false}, {"label": "D", "text": "Conduct disorder", "correct": true}], "correct_answer": "D. Conduct disorder", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Condu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child presents with skin eruptions upon exposure to sunlight and is diagnosed with a DNA repair defect. Which type of repair defect is most likely responsible?", "options": [{"label": "A", "text": "Nucleotide excision repair defect", "correct": true}, {"label": "B", "text": "Base excision repair defect", "correct": false}, {"label": "C", "text": "Mismatch repair defect", "correct": false}, {"label": "D", "text": "Recombination repair defect", "correct": false}], "correct_answer": "A. Nucleotide excision repair defect", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"94a2f0970016927771932885a3d362\"&gt;Nucleotide&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"20b3ce06c5169277718756ee95c1e9\"&gt;excision&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Drug for HIV induced lipodystrophy:", "options": [{"label": "A", "text": "Tesamorelin", "correct": true}, {"label": "B", "text": "Somatropin", "correct": false}, {"label": "C", "text": "Octreotide", "correct": false}, {"label": "D", "text": "Pegvisomant", "correct": false}], "correct_answer": "A. Tesamorelin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - T\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is a marker of Alzheimer’s disease?", "options": [{"label": "A", "text": "Synuclein", "correct": false}, {"label": "B", "text": "Αβ 40 and 42", "correct": true}, {"label": "C", "text": "Polyglutamine", "correct": false}, {"label": "D", "text": "FUS", "correct": false}], "correct_answer": "B. Αβ 40 and 42", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Αβ 40 and 42\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td><strong>Protein </strong></td>\n<td><strong>Disease </strong></td>\n</tr>\n<tr>\n<td>A β</td>\n<td>Alzheimer's Disease </td>\n</tr>\n<tr>\n<td>Alpha-synuclein </td>\n<td>Parkinson's disease </td>\n</tr>\n<tr>\n<td>Polyglutamine aggregates </td>\n<td>Huntington's disease </td>\n</tr>\n<tr>\n<td>FUS </td>\n<td>Frontotemporal <span class=\"customMeta\" data-dictid=\"82ded933641692777191ee421dc094\">lobar</span> degeneration </td>\n</tr>\n<tr>\n<td>TDP43</td>\n<td>Frontotemporal <span class=\"customMeta\" data-dictid=\"82ded933641692777191ee421dc094\">lobar</span> degeneration </td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 3-year-old boy presents with a rash, bleeding gums, and a positive tourniquet test. His platelet count is 25,000. Which of the following is the most important prognostic feature in this clinical scenario?", "options": [{"label": "A", "text": "Low platelet count", "correct": true}, {"label": "B", "text": "Elevated total leukocyte count (TLC)", "correct": false}, {"label": "C", "text": "Hematocrit", "correct": false}, {"label": "D", "text": "Peripheral smear", "correct": false}], "correct_answer": "A. Low platelet count", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Low &lt;span class=\"customMeta\" data-dictid=\"e7032bae7f1692777195d693722e54\"&gt;platelet&lt;/span&gt; cou\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents to the outpatient department (OPD) with recurrent diarrhea, abdominal pain, and foul-smelling stools. Colonoscopy following finding. what is the diagnosis?", "options": [{"label": "A", "text": "Pseudomembranous colitis", "correct": true}, {"label": "B", "text": "FAP", "correct": false}, {"label": "C", "text": "Ulcerative colitis", "correct": false}, {"label": "D", "text": "Acute gastritis", "correct": false}], "correct_answer": "A. Pseudomembranous colitis", "question_images": ["https://image.prepladder.com/content/AwtdnPBjGlnEKPVph3iq1724934834.png"], "explanation_images": ["https://image.prepladder.com/content/9IOTxRWvydAKkS1RmdgM1724934948.png"], "explanation": "<p>Correct Option A - Pseudomembranou\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young athlete underwent testing for a competition and was found to have hypertrophic cardiomyopathy. Which of the following will increase the murmur in this condition?", "options": [{"label": "A", "text": "Handgrip", "correct": false}, {"label": "B", "text": "Valsalva maneuver", "correct": true}, {"label": "C", "text": "Squatting", "correct": false}, {"label": "D", "text": "Leaning forward", "correct": false}], "correct_answer": "B. Valsalva maneuver", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Valsalva Maneuv\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old patient with a known case of homocystinuria presents with joint pain and weakness. Which vitamin is required for the treatment?", "options": [{"label": "A", "text": "Vitamin B6", "correct": true}, {"label": "B", "text": "Vitamin B12", "correct": false}, {"label": "C", "text": "Vitamin B1", "correct": false}, {"label": "D", "text": "Vitamin B7", "correct": false}], "correct_answer": "A. Vitamin B6", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Vitamin B6\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child presents with leukocoria and an intraocular mass. Microscopic examination reveals rosettes with scanty cytoplasm, and the mass is positive for synaptophysin and chromogranin. What is the diagnosis?", "options": [{"label": "A", "text": "Retinoblastoma", "correct": true}, {"label": "B", "text": "Medulloblastoma", "correct": false}, {"label": "C", "text": "Optic glioma", "correct": false}, {"label": "D", "text": "Choroidal melanoma", "correct": false}], "correct_answer": "A. Retinoblastoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/oBRXTKSEJ3pBtfFY1L7d1724831165.png"], "explanation": "<p>Correct Option A – R\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with foul-smelling sputum, breathlessness, and fever. Based on the X-ray below, what is the most likely diagnosis?", "options": [{"label": "A", "text": "Lung abscess", "correct": true}, {"label": "B", "text": "Pneumothorax", "correct": false}, {"label": "C", "text": "Pleural effusion", "correct": false}, {"label": "D", "text": "Pericardial effusion", "correct": false}], "correct_answer": "A. Lung abscess", "question_images": ["https://image.prepladder.com/content/Jrfi3lGdzMnHDoIjGDA51724912747.png"], "explanation_images": ["https://image.prepladder.com/content/hZq5fWm0HcAMhW40btmS1724932920.png", "https://image.prepladder.com/content/D1CGGLq8qWYSbQfbnxZk1724932876.png", "https://image.prepladder.com/content/4qA8io3paVEWrnqlHtfu1724932967.png"], "explanation": "<p>Correct Option A - Lung\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the given graph, identify the type of inhibition:", "options": [{"label": "A", "text": "Competitive", "correct": true}, {"label": "B", "text": "Non-competitive", "correct": false}, {"label": "C", "text": "Mixed", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "A. Competitive", "question_images": ["https://image.prepladder.com/content/GnRdsNVSUm75Bm2TEcqW1724833653.png"], "explanation_images": ["https://image.prepladder.com/content/DrqRgiLbJzVOUgQrxbPL1724847142.png"], "explanation": "<p>Correct Option A – Competitiv\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old patient is receiving a combination antiretroviral therapy including Zidovudine, Lamivudine, and Nevirapine for HIV management. Which of the following drugs should be avoided due to potential drug interactions with this regimen?", "options": [{"label": "A", "text": "Rifampicin", "correct": true}, {"label": "B", "text": "Streptomycin", "correct": false}, {"label": "C", "text": "INH", "correct": false}, {"label": "D", "text": "Ethambutol", "correct": false}], "correct_answer": "A. Rifampicin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - R\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the type of fracture healing you can expect in a fracture treated in a manner shown in the x ray?", "options": [{"label": "A", "text": "Primary healing", "correct": true}, {"label": "B", "text": "Secondary healing", "correct": false}, {"label": "C", "text": "Creeping substitution", "correct": false}, {"label": "D", "text": "Intramembranous ossification", "correct": false}], "correct_answer": "A. Primary healing", "question_images": ["https://image.prepladder.com/content/vN2p9JDN8Laf3SFQF3OR1724838309.png"], "explanation_images": [], "explanation": "<p>Correct Option A - Primary Healing\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with a history of hypertension presents with atrial fibrillation, shortness of breath and Bilateral basal crackles on auscultation. Least important in management would be:", "options": [{"label": "A", "text": "Start on anticoagulants like warf or Doac", "correct": false}, {"label": "B", "text": "Start beta blocker", "correct": true}, {"label": "C", "text": "Cardioversion to correct rhythm if hemodynamically remain unstable even after medical management", "correct": false}, {"label": "D", "text": "Iv Digoxin to control rate", "correct": false}], "correct_answer": "B. Start beta blocker", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Start &lt;span class=\"customMeta\" data-dictid=\"806eb8418c16927771822855b56695\"&gt;beta&lt;/span&gt; block\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Atrial <span class=\"customMeta\" data-dictid=\"6ae0ac06031692777202699c4c75a0\">Fibrillation</span> with Shortness of Breath</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Least Important</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Start <span class=\"customMeta\" data-dictid=\"806eb8418c16927771822855b56695\">Beta</span> Blocker</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Reason</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>In <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> settings with symptoms of <span class=\"customMeta\" data-dictid=\"1a5e87d16716927771888f364bce89\">heart failure</span> and <span class=\"customMeta\" data-dictid=\"cdf4a197dd16927771881a652c8328\">hemodynamic</span> instability, immediate rate control and rhythm <span class=\"customMeta\" data-dictid=\"6694ddb1db1692777199c9a1e38bf0\">stabilization</span> might take priority. <span class=\"customMeta\" data-dictid=\"806eb8418c16927771822855b56695\">Beta</span> blockers, while important, may not be the immediate choice in such scenarios compared to other options like anticoagulants, cardioversion, or IV digoxin.</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following diagnoses is an adnexal mass on ultrasound showing incomplete septation and a cogwheel appearance most consistent with?", "options": [{"label": "A", "text": "Hydrosalpinx", "correct": true}, {"label": "B", "text": "Follicular ovarian cyst", "correct": false}, {"label": "C", "text": "Endometriosis", "correct": false}, {"label": "D", "text": "Hemorrhagic ovarian cyst", "correct": false}], "correct_answer": "A. Hydrosalpinx", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A – H\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A hypertensive patient is suffering from frequent attacks of renal colic. Preferred anti hypertensive drug is:", "options": [{"label": "A", "text": "Ethacrynic acid", "correct": false}, {"label": "B", "text": "Acetazolamide", "correct": false}, {"label": "C", "text": "Hydrochlorothiazide", "correct": true}, {"label": "D", "text": "Spironolactone", "correct": false}], "correct_answer": "C. Hydrochlorothiazide", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Hydrochloroth\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with a tingling sensation in both legs, polyuria, and weight loss. Based on the given bone marrow aspirate findings, what is the most likely diagnosis?", "options": [{"label": "A", "text": "Multiple myeloma with renal failure", "correct": true}, {"label": "B", "text": "SACD with vitamin B12 deficiency", "correct": false}, {"label": "C", "text": "SACD with diabetes", "correct": false}, {"label": "D", "text": "Waldenstrom's Macroglobulinemia", "correct": false}], "correct_answer": "A. Multiple myeloma with renal failure", "question_images": ["https://image.prepladder.com/content/ah9a3OSrqzQkPhz8BRc51724851016.png"], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"652999e42416927771936e1f3246e3\"&gt;Multiple myeloma&lt;/span&gt; with &lt;span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\"&gt;renal&lt;/span&gt; failu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "At which of the following ages does maximum brain growth occur?", "options": [{"label": "A", "text": "1 year", "correct": true}, {"label": "B", "text": "2 years", "correct": false}, {"label": "C", "text": "3 years", "correct": false}, {"label": "D", "text": "4 years", "correct": false}], "correct_answer": "A. 1 year", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A central line infection is noted in an ICU patient, and staining shows a gram-positive oval-shaped organism that reproduces by budding. Identify the organism:", "options": [{"label": "A", "text": "Staphylococcus aureus", "correct": false}, {"label": "B", "text": "Candida", "correct": true}, {"label": "C", "text": "Staphylococcus epidermidis", "correct": false}, {"label": "D", "text": "Escherichia coli", "correct": false}], "correct_answer": "B. Candida", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/7dIgHs4VoVL8RapH6cYq1724838166.png"], "explanation": "<p>Correct Option B - C\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A floppy infant presents with hypotonia, hepatomegaly, and an X-ray showing cardiomegaly. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Pompe disease", "correct": true}, {"label": "B", "text": "Transposition of the Great Arteries (TGA)", "correct": false}, {"label": "C", "text": "Tetralogy of Fallot (TOF)", "correct": false}, {"label": "D", "text": "Ebstein's anomaly", "correct": false}], "correct_answer": "A. Pompe disease", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the appropriate management for a patient presenting with constant chest pain and radiological findings of stanford type A aortic dissection?", "options": [{"label": "A", "text": "Surgical management", "correct": true}, {"label": "B", "text": "Vasodilator", "correct": false}, {"label": "C", "text": "Beta blocker", "correct": false}, {"label": "D", "text": "Beta blocker plus vasodilator", "correct": false}], "correct_answer": "A. Surgical management", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"81d12f9cb01692777199e44ff3f3c1\"&gt;Surgical&lt;/span&gt; Manag\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the procedure commonly performed in patients with recurrent gastroesophageal reflux disease (GERD):", "options": [{"label": "A", "text": "360-degree Nissen fundoplication", "correct": true}, {"label": "B", "text": "Partial gastrectomy", "correct": false}, {"label": "C", "text": "Esophageal banding", "correct": false}, {"label": "D", "text": "270-degree Nissen fundoplication", "correct": false}], "correct_answer": "A. 360-degree Nissen fundoplication", "question_images": ["https://image.prepladder.com/content/suxu8Ejkc3Pq4mCVIdW01724935064.JPG"], "explanation_images": ["https://image.prepladder.com/content/S8b2tqxWD235yp1kSzzl1724916672.png", "https://image.prepladder.com/content/Vese8Dg7W5aYbC7IGSxO1724935788.png"], "explanation": "<p>Correct Option A - 360-degree Nissen fu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with respiratory distress and is diagnosed with pan-acinar emphysema. Which deficiency is responsible for his condition?", "options": [{"label": "A", "text": "Type 1 surfactant", "correct": false}, {"label": "B", "text": "Type 2 surfactant", "correct": false}, {"label": "C", "text": "Alpha-1 antitrypsin deficiency", "correct": true}, {"label": "D", "text": "Albumin", "correct": false}], "correct_answer": "C. Alpha-1 antitrypsin deficiency", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Alph\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young girl presents with multiple episodes of loss of consciousness, each lasting about 20 minutes. These episodes occur exclusively in front of her family and only during the daytime. There is no history of tongue biting or incontinence associated with the episodes. Both EEG and MRI brain scans are normal. What is the appropriate management for this patient?", "options": [{"label": "A", "text": "Treat with aversive therapy", "correct": false}, {"label": "B", "text": "Insight-oriented psychotherapy", "correct": true}, {"label": "C", "text": "Valproate", "correct": false}, {"label": "D", "text": "Ketogenic diet", "correct": false}], "correct_answer": "B. Insight-oriented psychotherapy", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/emTKyN3bzOCWI0u915Md1724911981.png"], "explanation": "<p>Correct Option B - Insight-oriented psychoth\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with raised triglyceride started on medication. He soon developed flushing, gout and raised liver enzymes. Likely cause is:", "options": [{"label": "A", "text": "Nicotinamide", "correct": true}, {"label": "B", "text": "Atorvastatin", "correct": false}, {"label": "C", "text": "Fenofibrate", "correct": false}, {"label": "D", "text": "Cholestyramine", "correct": false}], "correct_answer": "A. Nicotinamide", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"5eb9769383169277719347453a36cc\"&gt;Nicotinamide&lt;/span&gt; (Niacin)\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with anemia, neutropenia, and hypopigmentation of skin and hair. Which micronutrient deficiency is most likely?", "options": [{"label": "A", "text": "Zinc", "correct": false}, {"label": "B", "text": "Fluoride", "correct": false}, {"label": "C", "text": "Copper", "correct": true}, {"label": "D", "text": "Selenium", "correct": false}], "correct_answer": "C. Copper", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C – C\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following fractures can cause a deformity as shown in the image below?", "options": [{"label": "A", "text": "Lateral condyle of humerus fracture", "correct": false}, {"label": "B", "text": "Monteggia fracture", "correct": false}, {"label": "C", "text": "Supracondylar fracture of humerus", "correct": true}, {"label": "D", "text": "Shaft of humerus fracture", "correct": false}], "correct_answer": "C. Supracondylar fracture of humerus", "question_images": ["https://image.prepladder.com/content/TZW6B3O2yMsGqgdDFe5P1724909221.png"], "explanation_images": ["https://image.prepladder.com/content/NBQFzTnp9Zp9BSnnMf1w1724838850.png"], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"043a86fa0016927771998a67e65e6a\"&gt;Supracondylar&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"e3727bc4841692777203d62242b6e6\"&gt;fracture&lt;/span&gt; of humeru\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Diphenoxylate is used to treat secretory diarrhea, and it is often combined with atropine. What is the primary reason for this combination therapy?", "options": [{"label": "A", "text": "To correct the side effects of diphenoxylate", "correct": false}, {"label": "B", "text": "To enhance the antidiarrheal efficacy of diphenoxylate", "correct": false}, {"label": "C", "text": "To provide an additional antidiarrheal effect", "correct": false}, {"label": "D", "text": "To reduce the potential for abuse of diphenoxylate", "correct": true}], "correct_answer": "D. To reduce the potential for abuse of diphenoxylate", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - To reduce the potential for abuse of diph\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Arrange the following stages of the demographic cycle in the correct order: Early expanding High stationary Late expanding Low stationary", "options": [{"label": "A", "text": "1, 2, 3, 4", "correct": false}, {"label": "B", "text": "2, 1, 3, 4", "correct": true}, {"label": "C", "text": "1, 3, 2, 4", "correct": false}, {"label": "D", "text": "3, 2, 4, 1", "correct": false}], "correct_answer": "B. 2, 1, 3, 4", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/5FibZ9RMXGiaXWRdngd81724851172.png"], "explanation": "<p>Correct Option B - 2, 1, 3, 4\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 10-year-old child is diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) and is started on medication to increase norepinephrine levels as part of the treatment plan. Which of the following drugs is used for this purpose, and what is its mechanism of action?", "options": [{"label": "A", "text": "Methylphenidate", "correct": true}, {"label": "B", "text": "Reboxetine", "correct": false}, {"label": "C", "text": "Amitriptyline", "correct": false}, {"label": "D", "text": "Fluoxetine", "correct": false}], "correct_answer": "A. Methylphenidate", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Methylph\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Given 500 live births, 12 stillbirths, and 9 deaths within the first 7 days, calculate the Early Neonatal Mortality Rate (ENMR).", "options": [{"label": "A", "text": "18", "correct": true}, {"label": "B", "text": "36", "correct": false}, {"label": "C", "text": "24", "correct": false}, {"label": "D", "text": "50", "correct": false}], "correct_answer": "A. 18", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/hPrxR42XNGHlL9N50Zma1724761316.png", "https://image.prepladder.com/content/UYFC5wyPbC3iwtTbQ1G71724850579.png"], "explanation": "<p>Correct Option A\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the most effective drug to prescribe for a 25-year-old male patient with acne, as shown in the image?", "options": [{"label": "A", "text": "Topical tretinoin", "correct": false}, {"label": "B", "text": "Systemic doxycycline", "correct": false}, {"label": "C", "text": "Systemic minocycline", "correct": false}, {"label": "D", "text": "Systemic isotretinoin", "correct": true}], "correct_answer": "D. Systemic isotretinoin", "question_images": ["https://image.prepladder.com/notes/J0FZBoiFnbLmK0Kd5VXh1745181929.jpg"], "explanation_images": ["https://image.prepladder.com/content/b9dWgYmmxqepTQGXYwxr1724754855.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 5-year-old girl was washing her doll with shampoo containing rotenone. Her mother noticed her in unconscious state. Which is inhibited by the above chemical?", "options": [{"label": "A", "text": "NADH dehydrogenase", "correct": true}, {"label": "B", "text": "Succinate dehydrogenase", "correct": false}, {"label": "C", "text": "Cytochrome C", "correct": false}, {"label": "D", "text": "Cytochrome oxidase", "correct": false}], "correct_answer": "A. NADH dehydrogenase", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/W1MFyHVqR2X7TSUNG0KB1724848525.png"], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"70e624dfd41692777193efc364d5b4\"&gt;NADH&lt;/span&gt; dehydrog\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Reversal of the muscle relaxant by Vecuronium/rocuronium in patient with Renal failure is normally done by:", "options": [{"label": "A", "text": "Sugammadex", "correct": false}, {"label": "B", "text": "Neostigmine", "correct": true}, {"label": "C", "text": "Physostigmine", "correct": false}, {"label": "D", "text": "Rivastigmine", "correct": false}], "correct_answer": "B. Neostigmine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Neostig\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Most common cause of death in idiopathic pulmonary fibrosis?", "options": [{"label": "A", "text": "Respiratory failure", "correct": true}, {"label": "B", "text": "Pulmonary edema", "correct": false}, {"label": "C", "text": "Cancer", "correct": false}, {"label": "D", "text": "PAH", "correct": false}], "correct_answer": "A. Respiratory failure", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\"&gt;Respiratory&lt;/span&gt; failu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following stains can be used to identify a laryngeal mass during laryngeal examination?", "options": [{"label": "A", "text": "Congo red", "correct": false}, {"label": "B", "text": "Supravital stain", "correct": true}, {"label": "C", "text": "Silver nitrate", "correct": false}, {"label": "D", "text": "H and E", "correct": false}], "correct_answer": "B. Supravital stain", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Suprav\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "If the incubation period of a disease is 5-14 days, what should be the recommended quarantine period?", "options": [{"label": "A", "text": "5 days", "correct": false}, {"label": "B", "text": "10 days", "correct": false}, {"label": "C", "text": "14 days", "correct": true}, {"label": "D", "text": "20 days", "correct": false}], "correct_answer": "C. 14 days", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/yPAlrypLgQmODTl3PgZF1724851476.png"], "explanation": "<p>Correct Option C - 14\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with a growth over the penis that is classified as a T3 lesion, with no enlarged inguinal lymph nodes detected. What is the best method of management?", "options": [{"label": "A", "text": "Penectomy", "correct": false}, {"label": "B", "text": "Penectomy with orchidectomy", "correct": false}, {"label": "C", "text": "Penectomy with superficial/inguinal lymph node dissection(MODIFIED)", "correct": true}, {"label": "D", "text": "Penectomy with deep inguinal lymph node dissection", "correct": false}], "correct_answer": "C. Penectomy with superficial/inguinal lymph node dissection(MODIFIED)", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Penectomy with Superficial/Inguinal &lt;span class=\"customMeta\" data-dictid=\"4df97a6cbf169277719172fd1af767\"&gt;Lymph&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"b10ce4acbf169277719323ffd12306\"&gt;Node&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"e42da316b916927771860f0ba81c19\"&gt;Dissection&lt;/span&gt; (MODIFIED)\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Aprepitant, a drug used to prevent late-onset chemotherapy-induced nausea and vomiting, acts through which of the following mechanisms?", "options": [{"label": "A", "text": "NK-1 antagonist", "correct": true}, {"label": "B", "text": "NK-1 agonist", "correct": false}, {"label": "C", "text": "NK-3 antagonist", "correct": false}, {"label": "D", "text": "NK-2 antagonist", "correct": false}], "correct_answer": "A. NK-1 antagonist", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - NK-1 Antag\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with acute epigastric pain and an increase in serum lipase levels. Three days after stabilization, a chest X-ray is obtained. What is the most common pathology behind the chest X-ray findings?", "options": [{"label": "A", "text": "Increased PCWP", "correct": false}, {"label": "B", "text": "Pulmonary thromboembolism", "correct": false}, {"label": "C", "text": "Non cardiogenic pulmonary edema", "correct": true}, {"label": "D", "text": "Aspiration pneumonitis", "correct": false}], "correct_answer": "C. Non cardiogenic pulmonary edema", "question_images": ["https://image.prepladder.com/content/Kq6BqFfqwhfvuihJOjq11724848011.png"], "explanation_images": [], "explanation": "<p>Correct Option C - Non-cardiogenic &lt;span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\"&gt;pulmonary&lt;/span&g\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Acute <span class=\"customMeta\" data-dictid=\"98ea94d2c01692777194cc5ffee153\">Pancreatitis</span> with Non-cardiogenic <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">Pulmonary</span> Edema</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Key Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Acute epigastric pain, elevated <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> lipase, <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> inflammation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Common Chest <span class=\"customMeta\" data-dictid=\"fd0c8ab494169277720227102dc79a\">X-ray</span> Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Non-cardiogenic <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> (due to increased <span class=\"customMeta\" data-dictid=\"89e3252d5b16927771833fb9b432ae\">capillary</span> permeability)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Differential Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Differentiated from <span class=\"customMeta\" data-dictid=\"25ec593008169277718360336a849a\">cardiogenic</span> <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"18b452e75916927771864c9ad533e1\">edema</span> (increased PCWP), <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> <span class=\"customMeta\" data-dictid=\"1c07a1135f1692777187f547678386\">embolism</span> (more sudden <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> compromise), and <span class=\"customMeta\" data-dictid=\"831d67ad8a1692777182763ca62e4b\">aspiration</span> <span class=\"customMeta\" data-dictid=\"5a679034841692777196d988b49eb5\">pneumonitis</span> (associated with a history of aspiration)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Rationale</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>The <span class=\"customMeta\" data-dictid=\"8f2e7fd96116927771995b451b5c90\">systemic</span> <span class=\"customMeta\" data-dictid=\"9d21dd5d3116927771907405b181bc\">inflammatory</span> response in <span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\">acute</span> <span class=\"customMeta\" data-dictid=\"98ea94d2c01692777194cc5ffee153\">pancreatitis</span> can lead to non-cardiogenic <span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\">pulmonary</span> edema, a common <span class=\"customMeta\" data-dictid=\"8a6b09beac1692777184b08a2b5766\">complication</span> in severe cases</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with redness, extreme eye pain, and diminished vision. The patient frequently wears contact lenses. Which of the following organisms is most likely responsible for her condition?", "options": [{"label": "A", "text": "Staphylococcus aureus", "correct": false}, {"label": "B", "text": "Streptococcus pyogenes", "correct": false}, {"label": "C", "text": "Acanthamoeba", "correct": true}, {"label": "D", "text": "Listeria", "correct": false}], "correct_answer": "C. Acanthamoeba", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C – Acanth\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An elderly woman reports difficulty in buttoning her shirt and increased clumsiness during daily activities. On examination, she is unable to make an 'O' shape by opposing her thumb and index finger. Which of the following muscles is most likely involved?", "options": [{"label": "A", "text": "Opponens pollicis", "correct": false}, {"label": "B", "text": "Abductor pollicis brevis", "correct": true}, {"label": "C", "text": "Flexor pollicis brevis", "correct": false}, {"label": "D", "text": "Palmar interossei", "correct": false}], "correct_answer": "B. Abductor pollicis brevis", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Muscle Group</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Muscles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Function</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Innervation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Thenar muscles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>• <strong>Abductor pollicis brevis</strong></p>\n<p>• <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">Flexor</span> pollicis brevis</p>\n<p>• Opponens pollicis</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>• Abducts thumb</p>\n<p> </p>\n<p>• Flexes thumb</p>\n<p>• Opposes thumb</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>AbPB: <strong>Median nerve</strong> (recurrent branch)</p>\n<p>FPB: Dual (Median + Ulnar)</p>\n<p>OP: <span class=\"customMeta\" data-dictid=\"979385c98a1692777192fb1721a16e\">Median</span> (variable)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Hypothenar muscles</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>• <span class=\"customMeta\" data-dictid=\"1a19c0413216927771801f371db10e\">Abductor</span> <span class=\"customMeta\" data-dictid=\"71a5caf62116927771863da6f46ba3\">digiti</span> minimi</p>\n<p>• <span class=\"customMeta\" data-dictid=\"3674af39031692777202252504982a\">Flexor</span> <span class=\"customMeta\" data-dictid=\"71a5caf62116927771863da6f46ba3\">digiti</span> minimi brevis</p>\n<p>• Opponens <span class=\"customMeta\" data-dictid=\"71a5caf62116927771863da6f46ba3\">digiti</span> minimi</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Controls movement of little finger</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ulnar nerve (deep branch)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Lumbricals</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>• 1st &amp; 2nd (lateral)</p>\n<p>• 3rd &amp; 4th (medial)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Flex MCPs and extend IP joints</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lateral 2: <span class=\"customMeta\" data-dictid=\"979385c98a1692777192fb1721a16e\">Median</span> nerve</p>\n<p>Medial 2: <span class=\"customMeta\" data-dictid=\"d7fd512e881692777201909450fd8c\">Ulnar</span> nerve</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Palmar interossei</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>• Three muscles (unipennate)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Adduction of fingers (PAD)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ulnar nerve (deep branch)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Dorsal interossei</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>• Four muscles (bipennate)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Abduction of fingers (DAB)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ulnar nerve (deep branch)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Adductor pollicis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>• Oblique and <span class=\"customMeta\" data-dictid=\"a6260fa86416927772008d36bd7e5f\">transverse</span> heads</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Adducts the thumb</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ulnar nerve (deep branch)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Palmaris brevis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>• One small <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> muscle</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Tenses skin over <span class=\"customMeta\" data-dictid=\"33357d54b11692777189e2babd4674\">hypothenar</span> eminence</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Ulnar nerve (superficial branch)</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An unconscious patient found to have hot dry skin, dilated pupils, abnormal slurred speech. Most likely overdose is?", "options": [{"label": "A", "text": "Dhatura", "correct": true}, {"label": "B", "text": "Cannabis", "correct": false}, {"label": "C", "text": "Alcohol", "correct": false}, {"label": "D", "text": "Cocaine", "correct": false}], "correct_answer": "A. Dhatura", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Dhatu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with a nodulo-ulcerative lesion on the lower lip, as shown in the image. What is the best way to take a biopsy in this case?", "options": [{"label": "A", "text": "Superficial incisional with normal mucosa", "correct": false}, {"label": "B", "text": "Blush biopsy", "correct": false}, {"label": "C", "text": "Deep incisional with nodular part", "correct": false}, {"label": "D", "text": "Excisional biopsy", "correct": true}], "correct_answer": "D. Excisional biopsy", "question_images": ["https://image.prepladder.com/content/zFQ7QuBBXuhRiDD2A83P1724753822.png"], "explanation_images": [], "explanation": "<p>Correct Option D - E\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the diagnosis based on the image provided:", "options": [{"label": "A", "text": "Tuberculosis (TB)", "correct": false}, {"label": "B", "text": "Malakoplakia", "correct": true}, {"label": "C", "text": "Pyoderma gangrenosum", "correct": false}, {"label": "D", "text": "Squamous cell carcinoma (SCC)", "correct": false}], "correct_answer": "B. Malakoplakia", "question_images": ["https://image.prepladder.com/content/sc1W6ZHGYJaK0YDC6r7F1724851535.png"], "explanation_images": [], "explanation": "<p>Correct Option B – Malakoplak\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the condition based on the immunofluorescence pattern shown in the image.", "options": [{"label": "A", "text": "Lupus vulgaris", "correct": false}, {"label": "B", "text": "Pemphigus vulgaris", "correct": true}, {"label": "C", "text": "Bullous pemphigoid", "correct": false}, {"label": "D", "text": "Impetigo", "correct": false}], "correct_answer": "B. Pemphigus vulgaris", "question_images": ["https://image.prepladder.com/content/FhTm4bX5ZQUirkoxAI0D1724754033.png"], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"73d23b64831692777195fed10389ac\"&gt;Pemphigus&lt;/span&gt; vulg\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Implantation occurs on which day post fertilization?", "options": [{"label": "A", "text": "2", "correct": false}, {"label": "B", "text": "5", "correct": true}, {"label": "C", "text": "8", "correct": false}, {"label": "D", "text": "15", "correct": false}], "correct_answer": "B. 5", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/EVbaIaSewJwDTRwszUXh1747647055.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Stage</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Day (Post-Fertilization)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Key Event</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Fertilization</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Day 0</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Sperm fertilizes <span class=\"customMeta\" data-dictid=\"c6c40c102d1692777194a23b2674c4\">oocyte</span> in <span class=\"customMeta\" data-dictid=\"3c1c3aa8b91692777181989b80fab8\">ampulla</span> of <span class=\"customMeta\" data-dictid=\"efc83dab2c1692777202b5d1d06c4f\">fallopian</span> tube</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Zygote Formation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Day 1</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Single-cell <span class=\"customMeta\" data-dictid=\"0052ecdccc1692777202bad37cc0f1\">zygote</span> undergoes cleavage</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Morula Formation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Day 3-4</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>16-cell stage compacted into a solid ball</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blastocyst Formation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Day 5</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Fluid-filled <span class=\"customMeta\" data-dictid=\"ddba4206eb169277718335596e86da\">cavity</span> forms; <span class=\"customMeta\" data-dictid=\"ac9837c0c31692777183c690a5f233\">blastocyst</span> <strong>reaches the uterus</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Implantation Begins</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Day 5-6</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Blastocyst attaches to the endometrium</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Trophoblast Invasion</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Day 6-8</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Syncytiotrophoblast formation, hCG <span class=\"customMeta\" data-dictid=\"9b0ae3750916927771986c15d4ff4d\">secretion</span> begins</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Complete Implantation</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Day 9-10</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Blastocyst is fully embedded in the endometrial lining</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient has a history of infection by Enterohemorrhagic Escherichia coli (EHEC) 0157, H7. What does the \"H\" represent?", "options": [{"label": "A", "text": "Capsule", "correct": false}, {"label": "B", "text": "Flagella", "correct": true}, {"label": "C", "text": "Fimbriae", "correct": false}, {"label": "D", "text": "Lipopolysacharides", "correct": false}], "correct_answer": "B. Flagella", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Flag\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old woman presents with chronic pelvic pain and dysmenorrhea. An ultrasound (USG) shows a cystic ovarian mass with a \"ground glass\" appearance. Which of the following conditions is most likely associated with these findings?", "options": [{"label": "A", "text": "Intramural fibroid", "correct": false}, {"label": "B", "text": "Adenomyoma", "correct": false}, {"label": "C", "text": "Endometriosis", "correct": true}, {"label": "D", "text": "Myomatous polyp", "correct": false}], "correct_answer": "C. Endometriosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C – E\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presented with interstitial lung disease with an occupational history of working in a factory for 20 years and underwent a biopsy. Based on the findings, what is the most likely diagnosis?", "options": [{"label": "A", "text": "Stanosis", "correct": false}, {"label": "B", "text": "Silicosis", "correct": false}, {"label": "C", "text": "Byssinosis", "correct": false}, {"label": "D", "text": "Asbestosis", "correct": true}], "correct_answer": "D. Asbestosis", "question_images": ["https://image.prepladder.com/content/sl3yhWbdonZ7Cw0HapJH1724829010.png"], "explanation_images": ["https://image.prepladder.com/content/h3LlKILgI6q68VuFLteM1724829149.png"], "explanation": "<p>Correct Option D – A\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the type of uterus shown in the image.", "options": [{"label": "A", "text": "Bicornuate", "correct": false}, {"label": "B", "text": "Didelphys", "correct": true}, {"label": "C", "text": "Arcuate", "correct": false}, {"label": "D", "text": "Aseptate", "correct": false}], "correct_answer": "B. Didelphys", "question_images": ["https://image.prepladder.com/content/z00el8ELFFWSQ7NSpimh1724762606.png"], "explanation_images": [], "explanation": "<p>Correct Option B - Didelphys Uteru\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A farmer suffered a wound on the dorsum of his foot. It later involved the subcutaneous tissue and became a discharging ulcer. Microscopy reveals gram-positive branching filaments. Identify the organism.", "options": [{"label": "A", "text": "Nocardia", "correct": true}, {"label": "B", "text": "Sporothrix", "correct": false}, {"label": "C", "text": "Histoplasma", "correct": false}, {"label": "D", "text": "Candida", "correct": false}], "correct_answer": "A. Nocardia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/NCki77YjTTNCWEn1aONE1724837678.png", "https://image.prepladder.com/content/vpiAjvcJaNDF5AFNcVg71724837711.png", "https://image.prepladder.com/content/aduLZgBMn7xYi1jeGkrV1724837773.png", "https://image.prepladder.com/content/aOZETxFc09IdwQWKTNd61724837801.png", "https://image.prepladder.com/content/mEETIhEPuq6fchIXYdjA1724837864.png", "https://image.prepladder.com/content/zX6rPTxFKIwOtQ0U7BQS1724838039.png"], "explanation": "<p>Correct Option A - N\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following vaccine is kept at lowest level?", "options": [{"label": "A", "text": "OPV", "correct": true}, {"label": "B", "text": "DPT", "correct": false}, {"label": "C", "text": "Hep B", "correct": false}, {"label": "D", "text": "Rota", "correct": false}], "correct_answer": "A. OPV", "question_images": ["https://image.prepladder.com/content/zybjgrgOwfw10yM13PEn1724851062.PNG"], "explanation_images": ["https://image.prepladder.com/content/e3lRci92ucBetr2GnrWJ1724851113.png", "https://image.prepladder.com/content/OZuNGi8rXJ61m48lC1af1724851135.png"], "explanation": "<p>Correct Option A - OPV\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 20-year-old chronic alcoholic presents with severe hematemesis. An ultrasound (USG) shows distention of the portal vein, and the liver appears hyperechoic. Pantoprazole has been administered. What is the next appropriate step in management?", "options": [{"label": "A", "text": "Initiate a course of broad-spectrum antibiotics", "correct": false}, {"label": "B", "text": "Order a liver biopsy to assess for fibrosis", "correct": false}, {"label": "C", "text": "Administer intravenous fluids and electrolyte replacement", "correct": true}, {"label": "D", "text": "Perform an endoscopy to look for varices", "correct": false}], "correct_answer": "C. Administer intravenous fluids and electrolyte replacement", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Administer &lt;span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\"&gt;intravenous&lt;/span&gt; fluids and &lt;span class=\"customMeta\" data-dictid=\"2e0552462e16927771871413861fb7\"&gt;electrolyte&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Patient presenting with pain in back of thigh and leg after lifting heavy weights. Which segment is involved?", "options": [{"label": "A", "text": "L4", "correct": false}, {"label": "B", "text": "L5", "correct": false}, {"label": "C", "text": "S1", "correct": false}, {"label": "D", "text": "S2", "correct": true}], "correct_answer": "D. S2", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Who order the autopsy in case of RTA?", "options": [{"label": "A", "text": "Forensic expert", "correct": false}, {"label": "B", "text": "Police", "correct": true}, {"label": "C", "text": "Lawyer", "correct": false}, {"label": "D", "text": "forensic doctor", "correct": false}], "correct_answer": "B. Police", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - P\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child presents with deformities, normal serum calcium, normal PTH, low phosphate, and elevated ALP. Which is the most likely diagnosis?", "options": [{"label": "A", "text": "Hypophosphatemic rickets", "correct": true}, {"label": "B", "text": "Vitamin D Dependent Rickets Type 1 (VDDR type 1)", "correct": false}, {"label": "C", "text": "Vitamin D Dependent Rickets Type 2 (VDDR type 2)", "correct": false}, {"label": "D", "text": "Renal osteodystrophy", "correct": false}], "correct_answer": "A. Hypophosphatemic rickets", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Hypophosphatemic rick\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td><strong>Calcipenic rickets/Nutritional rickets </strong></td>\n<td><strong>Phosphoenic rickets/renal rickets</strong></td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Cause: <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">Deficiency</span> of <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> due to <span class=\"customMeta\" data-dictid=\"144d78fe4816927771852de984c62f\">defective</span> <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> absorption and improper supply of calcium.</li>\n<li>Low <span class=\"customMeta\" data-dictid=\"54de8b79a91692777183e608bc0dd4\">calcium</span> levels are present.</li>\n</ul>\n</td>\n<td>\n<ul>\n<li> It is due to low <span class=\"customMeta\" data-dictid=\"189b6fc834169277719580eb39bb4c\">phosphate</span> levels.</li>\n<li>It is caused by excessive <span class=\"customMeta\" data-dictid=\"0f7653c9ef1692777187deaa35f749\">excretion</span> in the kidney.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with follicular hyperkeratosis on the extensor aspect of the forearm and has a dietary history of Vitamin A and C deficiency. What is the diagnosis?", "options": [{"label": "A", "text": "Phrynoderma", "correct": true}, {"label": "B", "text": "Scurvy", "correct": false}, {"label": "C", "text": "Pellagra", "correct": false}, {"label": "D", "text": "Keratosis pilaris", "correct": false}], "correct_answer": "A. Phrynoderma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A – Ph\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the image given?", "options": [{"label": "A", "text": "Arohi from HIV", "correct": false}, {"label": "B", "text": "Sapna Leprosy", "correct": true}, {"label": "C", "text": "Meena Unicef", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "B. Sapna Leprosy", "question_images": ["https://image.prepladder.com/content/6Is32rHBzltiE5WJWnTT1724850660.png"], "explanation_images": ["https://image.prepladder.com/content/FCoz0rpYiQ0VX6l4CWJ61724850812.png", "https://image.prepladder.com/content/TIZakscBeHwj1AtHcz8o1724850928.png"], "explanation": "<p>Correct Option B - Sapna L\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What are the effects of a lesion in Brodmann area 22?", "options": [{"label": "A", "text": "Expressive aphasia", "correct": false}, {"label": "B", "text": "Receptive aphasia", "correct": true}, {"label": "C", "text": "Poor repetition of language", "correct": false}, {"label": "D", "text": "Poor naming", "correct": false}], "correct_answer": "B. Receptive aphasia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient is brought to the hospital following a road traffic accident (RTA). He presents with confusion, irritability, and tremors. The patient has a history of daily alcohol consumption. Which drug is most appropriate to prevent withdrawal symptoms in this patient?", "options": [{"label": "A", "text": "Fomepizole", "correct": false}, {"label": "B", "text": "Naltrexone", "correct": false}, {"label": "C", "text": "Lorazepam", "correct": true}, {"label": "D", "text": "Thiamine", "correct": false}], "correct_answer": "C. Lorazepam", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - L\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the confirmatory test for the above condition?", "options": [{"label": "A", "text": "CBNAAT of CSF", "correct": false}, {"label": "B", "text": "PET Scan", "correct": false}, {"label": "C", "text": "NMR Spectroscopy", "correct": true}, {"label": "D", "text": "MRI aerial scan", "correct": false}], "correct_answer": "C. NMR Spectroscopy", "question_images": ["https://image.prepladder.com/content/tsNQMEgOZh54SE8i59yS1724935249.png"], "explanation_images": [], "explanation": "<p>Correct Option C - NMR S\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td><strong>Condition</strong></td>\n<td>Differentiation between <span class=\"customMeta\" data-dictid=\"0617ad09441692777201a69289f441\">Tuberculoma</span> and <span class=\"customMeta\" data-dictid=\"c3a0aace09169277719372a3673fa8\">Neurocysticercosis</span> in cases of ring-enhancing brain lesions.</td>\n</tr>\n<tr>\n<td><strong>Key <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">Diagnostic</span> Modality</strong></td>\n<td>NMR Spectroscopy</td>\n</tr>\n<tr>\n<td><strong>Associated <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">Imaging</span> Findings</strong></td>\n<td>Ring-enhancing lesions on MRI, which may be indicative of either <span class=\"customMeta\" data-dictid=\"0617ad09441692777201a69289f441\">tuberculoma</span> or neurocysticercosis.</td>\n</tr>\n<tr>\n<td><strong>Rationale for Diagnosis</strong></td>\n<td>NMR <span class=\"customMeta\" data-dictid=\"b858e183101692777198186309ea61\">Spectroscopy</span> provides detailed biochemical and chemical information about lesions, helping <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> between <span class=\"customMeta\" data-dictid=\"0617ad09441692777201a69289f441\">tuberculoma</span> and neurocysticercosis.</td>\n</tr>\n<tr>\n<td><strong>Differential Diagnosis</strong></td>\n<td>Use of <span class=\"customMeta\" data-dictid=\"b52e55eaf516927771936aa6597a65\">NMR</span> <span class=\"customMeta\" data-dictid=\"b858e183101692777198186309ea61\">Spectroscopy</span> to <span class=\"customMeta\" data-dictid=\"c9001edbf216927771860f3475b44c\">differentiate</span> between <span class=\"customMeta\" data-dictid=\"0617ad09441692777201a69289f441\">tuberculoma</span> (caused by TB) and <span class=\"customMeta\" data-dictid=\"c3a0aace09169277719372a3673fa8\">neurocysticercosis</span> (caused by <span class=\"customMeta\" data-dictid=\"257d4bebe61692777200356be57185\">Taenia</span> solium).</td>\n</tr>\n<tr>\n<td><strong>Importance of Confirmation</strong></td>\n<td>Accurate <span class=\"customMeta\" data-dictid=\"55a682d72e16927771865bb4855ba3\">differentiation</span> between these conditions is crucial for appropriate treatment decisions (antitubercular therapy vs. <span class=\"customMeta\" data-dictid=\"d12d4e204f16927771816b085d8b78\">antiparasitic</span> therapy).</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following drugs will cause Torsades de pointes if given with erythromycin?", "options": [{"label": "A", "text": "Astemizole", "correct": true}, {"label": "B", "text": "Levofloxacin", "correct": false}, {"label": "C", "text": "Amoxicillin", "correct": false}, {"label": "D", "text": "Ceftriaxone", "correct": false}], "correct_answer": "A. Astemizole", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - A\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Patient presents with features of right heart failure and exhibits a rapid Y descent on cardiac examination. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Constrictive pericarditis", "correct": true}, {"label": "B", "text": "Cardiac tamponade", "correct": false}, {"label": "C", "text": "Pulmonary hypertension", "correct": false}, {"label": "D", "text": "Right ventricular infarction", "correct": false}], "correct_answer": "A. Constrictive pericarditis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"49386582661692777185faf9eaa8d8\"&gt;Constrictive&lt;/span&gt; P\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old female, gravida 2, para 2, with a history of cervical lengthening, is considering surgical options. Given her history, what is the choice of surgery?", "options": [{"label": "A", "text": "Fothergill", "correct": true}, {"label": "B", "text": "McCall", "correct": false}, {"label": "C", "text": "Lefort", "correct": false}, {"label": "D", "text": "Hysterectomy", "correct": false}], "correct_answer": "A. Fothergill", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Aldrich mees lines and raindrop pigmentation in hand is seen in which poisoning?", "options": [{"label": "A", "text": "Arsenic", "correct": true}, {"label": "B", "text": "Thallium", "correct": false}, {"label": "C", "text": "Cadmium", "correct": false}, {"label": "D", "text": "Lead", "correct": false}], "correct_answer": "A. Arsenic", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - A\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child is brought to the OPD by his parents with complaints of recurrent infections. On mediastinal imaging, the thymus gland was found to be absent. Based on further investigation, ADA levels are low. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Bruton's hypogammaglobulinemia", "correct": false}, {"label": "B", "text": "Bare lymphocyte syndrome", "correct": false}, {"label": "C", "text": "DiGeorge syndrome", "correct": false}, {"label": "D", "text": "Severe combined immunodeficiency", "correct": true}], "correct_answer": "D. Severe combined immunodeficiency", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Severe combined immu\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:529px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>XLR ( <span class=\"customMeta\" data-dictid=\"dd35346fc716927772029e2f0bb10f\">X-linked</span> <span class=\"customMeta\" data-dictid=\"d54db2110416927771971e7c011a9f\">recessive</span> variety)</strong></p>\n<p> </p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>AR ( Autosomal <span class=\"customMeta\" data-dictid=\"d54db2110416927771971e7c011a9f\">recessive</span> variety)</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<ul>\n<li>Most common</li>\n<li>Defect in the <span class=\"customMeta\" data-dictid=\"49be0416121692777188dc8944b7bc\">gamma</span> subunit of <span class=\"customMeta\" data-dictid=\"0ac01cc0c31692777185cae5f28175\">cytokine</span> receptors: IL2, IL4, IL7, Il15.</li>\n<li>IL 2 and <span class=\"customMeta\" data-dictid=\"87906574d616927771895ad1e8ffcc\">IL</span> 15: <span class=\"customMeta\" data-dictid=\"144d78fe4816927771852de984c62f\">Defective</span> NK cells</li>\n<li>IL 4: No <span class=\"customMeta\" data-dictid=\"9d7a12cab116927771811a0079086d\">antibody</span> production</li>\n<li>IL 7: <span class=\"customMeta\" data-dictid=\"144d78fe4816927771852de984c62f\">Defective</span> T-cell development</li>\n<li>B cells function normally.</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>There are three types of AR :</p>\n<ul>\n<li>Adenosine <span class=\"customMeta\" data-dictid=\"8da63c3e5316927771852b78bac0ba\">deaminase</span> <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> (most common): Involves all cells (B cells, T cells, and NK cells)</li>\n<li>JAK-3 defects: It affects <span class=\"customMeta\" data-dictid=\"0ac01cc0c31692777185cae5f28175\">cytokine</span> development. <span class=\"customMeta\" data-dictid=\"144d78fe4816927771852de984c62f\">Defective</span> T cells and NK cells. B cells function normally.</li>\n<li>RAG1 and RAG2 (Recombinant <span class=\"customMeta\" data-dictid=\"ba6b77f29316927771807350f86ce2\">activation</span> gene) defect: This gene is needed to develop B cell and T cell receptors. When this gene is affected, defects in B cells and T cells are observed. NK cells function normally.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 2-month-old child is brought to the ophthalmology OPD with the following presentation. What is the ideal management?", "options": [{"label": "A", "text": "Medical management", "correct": false}, {"label": "B", "text": "Operate immediately", "correct": true}, {"label": "C", "text": "Surgery after 6 months", "correct": false}, {"label": "D", "text": "Surgery after 2 years", "correct": false}], "correct_answer": "B. Operate immediately", "question_images": ["https://image.prepladder.com/content/otp6QfQe1sIMWsNbK88p1724833060.png"], "explanation_images": [], "explanation": "<p>Correct Option B - O\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The PR interval was measured at 0.21 seconds in a routine ECG of the patient. What is the correct Interpretation?", "options": [{"label": "A", "text": "Second degree HB", "correct": false}, {"label": "B", "text": "First degree HB", "correct": true}, {"label": "C", "text": "Normal rhythm", "correct": false}, {"label": "D", "text": "Complete HB", "correct": false}], "correct_answer": "B. First degree HB", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - First degree HB\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "For a woman with a 10-week period of gestation (POG) who seeks medical termination of pregnancy, the appropriate choice would be?", "options": [{"label": "A", "text": "Mifepristone and misoprostol", "correct": true}, {"label": "B", "text": "Dinoprostone", "correct": false}, {"label": "C", "text": "Oxytocin", "correct": false}, {"label": "D", "text": "Intrauterine hyper osmolar saline", "correct": false}], "correct_answer": "A. Mifepristone and misoprostol", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/3ZjFcf6hQv4EtB0WPb5q1724828789.png"], "explanation": "<p>Correct Option A\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient was brought to the emergency department with a history of fall and head injury. What is the diagnosis?", "options": [{"label": "A", "text": "EDH", "correct": false}, {"label": "B", "text": "SDH", "correct": true}, {"label": "C", "text": "SAH", "correct": false}, {"label": "D", "text": "Contusion", "correct": false}], "correct_answer": "B. SDH", "question_images": ["https://image.prepladder.com/content/k28Xszr6ZTtMbZnIzJQg1724838186.png"], "explanation_images": ["https://image.prepladder.com/content/BLof4iiVir5MjD6Weyf61724913688.png"], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"a9f86efa0d169277719911e454bd12\"&gt;Subdural&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"832849414c1692777188491f77bb5f\"&gt;Hematoma&lt;/span&gt; (SDH)\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which sinus drainage is obstructed in the image provided?", "options": [{"label": "A", "text": "Maxillary", "correct": true}, {"label": "B", "text": "Ethmoid", "correct": false}, {"label": "C", "text": "Sphenoid", "correct": false}, {"label": "D", "text": "Frontal", "correct": false}], "correct_answer": "A. Maxillary", "question_images": ["https://image.prepladder.com/content/y9rNFaiYLgEvqg023g9w1724840438.png"], "explanation_images": [], "explanation": "<p>Correct Option A - M\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Loading dose of drug is dependent on:", "options": [{"label": "A", "text": "Clearance", "correct": false}, {"label": "B", "text": "Route of administration", "correct": false}, {"label": "C", "text": "Volume of distribution", "correct": true}, {"label": "D", "text": "Bioavailability", "correct": false}], "correct_answer": "C. Volume of distribution", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/1ggOwLxy81Tj2OAKBZCR1724824047.png"], "explanation": "<p>Correct Option C - Volume of distribu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is true regarding adipocere formation?", "options": [{"label": "A", "text": "Preservation by saponification", "correct": true}, {"label": "B", "text": "High temperature needed", "correct": false}, {"label": "C", "text": "Cool and dry climate needed", "correct": false}, {"label": "D", "text": "Occurs within minutes to hours", "correct": false}], "correct_answer": "A. Preservation by saponification", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Preserv\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the maneuver shown in the image.", "options": [{"label": "A", "text": "Burn-Marshall Maneuver", "correct": true}, {"label": "B", "text": "Lovset Maneuver", "correct": false}, {"label": "C", "text": "Mauriceau-Smellie-Veit Maneuver", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "A. Burn-Marshall Maneuver", "question_images": ["https://image.prepladder.com/content/LkVssqADrzVbD5isnJK21724934996.png"], "explanation_images": ["https://image.prepladder.com/content/dGAnsBTowGo7S69VxrkG1724828458.png", "https://image.prepladder.com/content/mnqR3pJWEXxI6ZIB9Kzd1724828584.png", "https://image.prepladder.com/content/5pS7Lq9fz3m0tZ5xh1Jw1724825189.png"], "explanation": "<p>Correct Option A - Burn-Marshall Maneuv\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the bullet range", "options": [{"label": "A", "text": "Distant range", "correct": false}, {"label": "B", "text": "Close contact", "correct": false}, {"label": "C", "text": "Close range", "correct": true}, {"label": "D", "text": "Can not be predicted", "correct": false}], "correct_answer": "C. Close range", "question_images": ["https://image.prepladder.com/content/SEaAII9y8MfvJiuBs9b71724824001.png"], "explanation_images": [], "explanation": "<p>Correct Option C - Close rang\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the defect shown in the image given below:", "options": [{"label": "A", "text": "Binasal hemianopia", "correct": false}, {"label": "B", "text": "Bitemporal hemianopia", "correct": false}, {"label": "C", "text": "Homonymous hemianopia", "correct": true}, {"label": "D", "text": "Altitudinal defect", "correct": false}], "correct_answer": "C. Homonymous hemianopia", "question_images": ["https://image.prepladder.com/content/t5TYzgvIGmd5koHHzCaS1724757126.png"], "explanation_images": ["https://image.prepladder.com/content/AuvqCY8ouF4cPln8HCM21724910043.png"], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"0600a6b52316927771899e12e7ec86\"&gt;Homonymous&lt;/span&gt; h\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the diagnosis?", "options": [{"label": "A", "text": "Anencephaly", "correct": true}, {"label": "B", "text": "Hydranencephaly", "correct": false}, {"label": "C", "text": "Spinal bifida", "correct": false}, {"label": "D", "text": "Lissencephaly", "correct": false}], "correct_answer": "A. Anencephaly", "question_images": ["https://image.prepladder.com/content/A67xP60g2U0a7ErxA4DT1724847935.png"], "explanation_images": ["https://image.prepladder.com/content/9uAOOv2vWtcwGY9kinvP1724824133.png"], "explanation": "<p>Correct Option A\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35-year-old female with a long-standing history of fever presents with discoloration of the skin over the lower limb and edema. Microscopy reveals a sheathed organism with no nuclei at the tip of the tail. What is the most likely causative organism?", "options": [{"label": "A", "text": "Wuchereria bancrofti", "correct": true}, {"label": "B", "text": "Brugia malayi", "correct": false}, {"label": "C", "text": "Loa Loa", "correct": false}, {"label": "D", "text": "Mansonelia", "correct": false}], "correct_answer": "A. Wuchereria bancrofti", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/RyR5JriE0C5VEKtuhQlM1724838964.png"], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"afbac905ef1692777202ab62b5c1be\"&gt;Wuchereria&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with hematuria and flank pain. A renal mass is shown in the image provided. What is the likely diagnosis?", "options": [{"label": "A", "text": "Clear cell carcinoma", "correct": false}, {"label": "B", "text": "Papillary renal cell carcinoma", "correct": false}, {"label": "C", "text": "Chromophobe renal cell carcinoma", "correct": true}, {"label": "D", "text": "Bellini duct carcinoma", "correct": false}], "correct_answer": "C. Chromophobe renal cell carcinoma", "question_images": ["https://image.prepladder.com/content/Ld0HHfbL2NgU0hEmdINE1724851374.png"], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"cbc547b67e169277718420dd29912f\"&gt;Chromophobe&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\"&gt;renal&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A singer presents with singing at high pitch. On examination, bowing of the vocal cord is seen on the right side. Which of the following muscles has been compromised?", "options": [{"label": "A", "text": "Posterior cricoarytenoid", "correct": false}, {"label": "B", "text": "Lateral cricoarytenoid", "correct": false}, {"label": "C", "text": "Cricothyroid", "correct": true}, {"label": "D", "text": "Thyroarytenoid", "correct": false}], "correct_answer": "C. Cricothyroid", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Cricoth\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "How does the graft get nutrition on day 3?", "options": [{"label": "A", "text": "Imbibition", "correct": false}, {"label": "B", "text": "Inosculation", "correct": true}, {"label": "C", "text": "Neovascularization", "correct": false}, {"label": "D", "text": "None", "correct": false}], "correct_answer": "B. Inosculation", "question_images": [], "explanation_images": [], "explanation": "<p>Correct option B -Inosculation</p>\n<table>\n<thead>\n<tr>\n<th>Day</th>\n<th>Nutritional Mechanism</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>0–2</td>\n<td>Plasmatic <span class=\"customMeta\" data-dictid=\"dff144d1e51692777189acef767a18\">imbibition</span> (diffusion)</td>\n</tr>\n<tr>\n<td>~3</td>\n<td>Inosculation (capillary connections form)</td>\n</tr>\n<tr>\n<td>4–7</td>\n<td>Neovascularization (new vessels grow in)</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 55-year-old woman presents with a gradually progressive hearing loss in her right ear, accompanied by pulsatile tinnitus. On otoscopic examination, a red vascular mass is seen behind the tympanic membrane. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Cholesteatoma", "correct": false}, {"label": "B", "text": "Glomus Tympanicum", "correct": true}, {"label": "C", "text": "Acoustic Neuroma", "correct": false}, {"label": "D", "text": "Otosclerosis", "correct": false}], "correct_answer": "B. Glomus Tympanicum", "question_images": ["https://image.prepladder.com/content/j0oQZ0AisMT94ke6RVTL1724908951.png"], "explanation_images": [], "explanation": "<p>Correct Option B - Glomus Tympanicu\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is this grid system used for?", "options": [{"label": "A", "text": "Prolapse", "correct": true}, {"label": "B", "text": "Vulvar cancer", "correct": false}, {"label": "C", "text": "Endometrial cancer", "correct": false}, {"label": "D", "text": "Abruption placenta", "correct": false}], "correct_answer": "A. Prolapse", "question_images": ["https://image.prepladder.com/content/Fv9xEjrOv5064Dpn8tBX1724829513.png"], "explanation_images": [], "explanation": "<p>Correct Option A\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An alcoholic patient with a 10-day history of binge drinking presents with altered sensorium, slurred speech, and unconsciousness, with a blood glucose level of 49 mg/dL. What is the most appropriate treatment?", "options": [{"label": "A", "text": "Intravenous thiamine infusion followed by dextrose", "correct": true}, {"label": "B", "text": "Intravenous vitamin K followed by dextrose", "correct": false}, {"label": "C", "text": "Only dextrose infusion", "correct": false}, {"label": "D", "text": "Oral thiamine followed by dextrose", "correct": false}], "correct_answer": "A. Intravenous thiamine infusion followed by dextrose", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"27b78a96071692777190f4dfb93430\"&gt;Intravenous&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"b70d1dbde516927772000d7774d2a5\"&gt;thiamine&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"3562d699c516927771909a426ea8ef\"&gt;infusion&lt;/span&g\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Alcoholic <span class=\"customMeta\" data-dictid=\"78c658d4ed1692777189098c7544b9\">hypoglycemia</span> with risk of Wernicke's encephalopathy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Immediate Concern</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Preventing Wernicke's encephalopathy</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Required Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Intravenous <span class=\"customMeta\" data-dictid=\"b70d1dbde516927772000d7774d2a5\">thiamine</span> infusion</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Subsequent Treatment</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dextrose <span class=\"customMeta\" data-dictid=\"3562d699c516927771909a426ea8ef\">infusion</span> to correct hypoglycemia</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Rationale</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Thiamine <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> in <span class=\"customMeta\" data-dictid=\"f8b7fb6b0916927771811841fcd9fa\">alcoholism</span> can lead to neurological damage if <span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\">glucose</span> is given without thiamine.</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child presents with generalized body aches, poor wound healing, and corkscrew hairs on her arms, and white lines of Frenkel on X-ray as shown below. This clinical presentation is most consistent with which of the following deficiencies?", "options": [{"label": "A", "text": "Zinc deficiency", "correct": false}, {"label": "B", "text": "Vitamin C deficiency", "correct": true}, {"label": "C", "text": "Copper deficiency", "correct": false}, {"label": "D", "text": "Iron deficiency", "correct": false}], "correct_answer": "B. Vitamin C deficiency", "question_images": ["https://image.prepladder.com/content/pmXJLxqF7m8UjxDNmoi91724928017.png"], "explanation_images": [], "explanation": "<p>Correct Option B\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the correct order of disaster management steps?", "options": [{"label": "A", "text": "Impact-Response- Rehab-Mitigation", "correct": true}, {"label": "B", "text": "Response- Rehab- Mitigation- Impact", "correct": false}, {"label": "C", "text": "Rehab- mItigation-Response-Impact", "correct": false}, {"label": "D", "text": "Mitigation-Response-Impact-Rehab", "correct": false}], "correct_answer": "A. Impact-Response- Rehab-Mitigation", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/qePL1eo51JVAr5XkJ60N1724851217.png"], "explanation": "<p>Correct Option A: Impact - Response - Rehab - Mitig\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old woman presents with a history of cervical erosion and spotting for the past 2 months. What is the next best investigation for this patient?", "options": [{"label": "A", "text": "LBC + HPV", "correct": true}, {"label": "B", "text": "Pap smear + HSV", "correct": false}, {"label": "C", "text": "Pap smear + HBV", "correct": false}, {"label": "D", "text": "LBC + HSV", "correct": false}], "correct_answer": "A. LBC + HPV", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following drugs is appropriate for treating a 75-year-old woman with urinary incontinence triggered by stress, such as coughing?", "options": [{"label": "A", "text": "Ipratropium", "correct": false}, {"label": "B", "text": "Tolterodine", "correct": true}, {"label": "C", "text": "Telenzepine", "correct": false}, {"label": "D", "text": "Tropicamide", "correct": false}], "correct_answer": "B. Tolterodine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - T\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td><strong>Drug</strong></td>\n<td><strong>Mechanism of Action</strong></td>\n</tr>\n<tr>\n<td><strong>Tolterodine</strong></td>\n<td>Selective <span class=\"customMeta\" data-dictid=\"0ad3c97c2916927771938768dcf298\">muscarinic</span> <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antagonist</td>\n</tr>\n<tr>\n<td><strong>Oxybutynin</strong></td>\n<td>Muscarinic <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antagonist</td>\n</tr>\n<tr>\n<td><strong>Solifenacin</strong></td>\n<td>M3 selective <span class=\"customMeta\" data-dictid=\"0ad3c97c2916927771938768dcf298\">muscarinic</span> <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antagonist</td>\n</tr>\n<tr>\n<td><strong>Darifenacin</strong></td>\n<td>M3 selective <span class=\"customMeta\" data-dictid=\"0ad3c97c2916927771938768dcf298\">muscarinic</span> <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antagonist</td>\n</tr>\n<tr>\n<td><strong>Fesoterodine</strong></td>\n<td>Prodrug of tolterodine, <span class=\"customMeta\" data-dictid=\"0ad3c97c2916927771938768dcf298\">muscarinic</span> antagonist</td>\n</tr>\n<tr>\n<td><strong>Trospium</strong></td>\n<td>Muscarinic <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antagonist</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old male presents as calm and charming in front of a psychiatrist. However, he engages in aggressive behavior towards friends, frequently skips classes, disregards traffic rules and has been involved in a police interrogation. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Antisocial Personality Disorder", "correct": true}, {"label": "B", "text": "Narcissistic Personality Disorder", "correct": false}, {"label": "C", "text": "Schizotypal Personality Disorder", "correct": false}, {"label": "D", "text": "Paranoid Personality Disorder", "correct": false}], "correct_answer": "A. Antisocial Personality Disorder", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the condition depicted in the radiograph below.", "options": [{"label": "A", "text": "Pancreatic calcification", "correct": true}, {"label": "B", "text": "Mesenteric calcification", "correct": false}, {"label": "C", "text": "Horseshoe kidney", "correct": false}, {"label": "D", "text": "Jejunal fecolith", "correct": false}], "correct_answer": "A. Pancreatic calcification", "question_images": ["https://image.prepladder.com/content/KbJtOiADxXdDCJNhbYVo1724751554.png"], "explanation_images": [], "explanation": "<p>Correct Option A - P\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which is not the component of PQLI?", "options": [{"label": "A", "text": "Life expectancy at 1 year", "correct": false}, {"label": "B", "text": "Literacy rate", "correct": false}, {"label": "C", "text": "Infant mortality rate", "correct": false}, {"label": "D", "text": "Gross national product", "correct": true}], "correct_answer": "D. Gross national product", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/yjlyohal8Ik9ybnqo4IZ1724851339.png"], "explanation": "<p>Correct Option D - Gross national produ\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Linear growth of bone is disturbed when a fracture occurs in which of the following locations?", "options": [{"label": "A", "text": "Epiphysis", "correct": false}, {"label": "B", "text": "Diaphysis", "correct": false}, {"label": "C", "text": "Metaphysis", "correct": false}, {"label": "D", "text": "Epiphyseal plate", "correct": true}], "correct_answer": "D. Epiphyseal plate", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"dc486020a916927771874098596bbc\"&gt;Epiphyseal&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which area is affected by the fracture shown in the given X-ray?", "options": [{"label": "A", "text": "Tibial tuberosity fracture", "correct": true}, {"label": "B", "text": "Medial epicondyle of tibia", "correct": false}, {"label": "C", "text": "Gerdy's tubercle fracture", "correct": false}, {"label": "D", "text": "Osgood-Schlatter disease", "correct": false}], "correct_answer": "A. Tibial tuberosity fracture", "question_images": ["https://image.prepladder.com/content/nP07tuDaMr0mhQB0xK201724759039.png"], "explanation_images": [], "explanation": "<table>\n<thead>\n<tr>\n<th>Feature</th>\n<th>Description</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>Location</td>\n<td>Anterior <span class=\"customMeta\" data-dictid=\"bdbac654081692777196f9aab116f0\">proximal</span> <span class=\"customMeta\" data-dictid=\"ca6af868811692777200ce067e9db9\">tibia</span> (tibial tuberosity)</td>\n</tr>\n<tr>\n<td>Mechanism</td>\n<td>Forceful <span class=\"customMeta\" data-dictid=\"ca2289e348169277718516017eb2ba\">contraction</span> of <span class=\"customMeta\" data-dictid=\"175fd4b3061692777196c7f28a4c53\">quadriceps</span> (e.g., jumping, kicking)</td>\n</tr>\n<tr>\n<td>Radiograph finding</td>\n<td>Fracture through or below the <span class=\"customMeta\" data-dictid=\"f2a519f38316927772004fe7c606af\">tibial</span> tuberosity</td>\n</tr>\n<tr>\n<td>Associated conditions</td>\n<td>May be associated with <strong>Osgood-Schlatter disease</strong> as a <span class=\"customMeta\" data-dictid=\"80c0cb2a5f1692777196ba45847553\">predisposing</span> factor</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old patient undergoing orthopedic surgery who underwent general anesthesia suddenly developed a rise in EtCO2, temperature, and also muscle rigidity. Which of the following drugs leads to such complications?", "options": [{"label": "A", "text": "Propofol", "correct": false}, {"label": "B", "text": "Nitrous oxide", "correct": false}, {"label": "C", "text": "Etomidate", "correct": false}, {"label": "D", "text": "Halothane", "correct": true}], "correct_answer": "D. Halothane", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/dRKSX0ygu2jd8OZ6Ly681724836166.png", "https://image.prepladder.com/content/NCwvBnX9nw1oiHUIFNeo1724836174.png"], "explanation": "<p>Correct Option D – Haloth\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Methotrexate usage causes reduced synthesis of:", "options": [{"label": "A", "text": "TMP", "correct": true}, {"label": "B", "text": "CMP", "correct": false}, {"label": "C", "text": "GMP", "correct": false}, {"label": "D", "text": "AMP", "correct": false}], "correct_answer": "A. TMP", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - TMP (Thymidine Monophosphate)\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A singer is finding difficulty in raising the pitch of her voice. On examination, her vocal cords were depressed and bowing. Which of the following muscles is involved?", "options": [{"label": "A", "text": "Cricothyroid", "correct": true}, {"label": "B", "text": "Interarytenoid", "correct": false}, {"label": "C", "text": "Posterior cricoarytenoid", "correct": false}, {"label": "D", "text": "Lateral arytenoid", "correct": false}], "correct_answer": "A. Cricothyroid", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/cxe33Y09Y72fD22rPHeu1724839745.png"], "explanation": "<p>Correct Option A - Cricoth\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child presents to the OPD with intracranial diffuse calcifications, chorioretinitis, and hydrocephalus. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Congenital Toxoplasmosis", "correct": true}, {"label": "B", "text": "Dandy-Walker Malformation", "correct": false}, {"label": "C", "text": "Budd-Chiari Syndrome", "correct": false}, {"label": "D", "text": "Congenital Hydrocephalus", "correct": false}], "correct_answer": "A. Congenital Toxoplasmosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\"&gt;Congenital&lt;/span&gt; T\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A mother brings her daughter to the emergency room, reporting that she ingested an unknown substance. She presents with hypertension, tachycardia, hyperthermia, and mydriasis. Which of the following substances is most likely responsible for these symptoms?", "options": [{"label": "A", "text": "Heroin", "correct": false}, {"label": "B", "text": "Morphine", "correct": false}, {"label": "C", "text": "Cocaine", "correct": true}, {"label": "D", "text": "Chlorpheniramine", "correct": false}], "correct_answer": "C. Cocaine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C – C\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Persistent occipito-posterior (OP) face-to-pubes delivery is seen in which type of pelvis?", "options": [{"label": "A", "text": "Android", "correct": false}, {"label": "B", "text": "Gynecoid", "correct": false}, {"label": "C", "text": "Anthropoid", "correct": true}, {"label": "D", "text": "Platypelloid", "correct": false}], "correct_answer": "C. Anthropoid", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ay4YfFByod1OibCNWTD71724822368.png", "https://image.prepladder.com/content/JDiOmH5AE1iRBknZc5gH1724822430.png"], "explanation": "<p>Correct Option C - Anth\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the receptors with their correct function: 1. Ruffini corpuscle A. Vibration 2. Merkel cells B. Sustained pressure 3. Pacinian corpuscle C. Stretching 4. Meissner’s corpuscle D. Fine touch", "options": [{"label": "A", "text": "1C, 2B, 3A, 4D", "correct": true}, {"label": "B", "text": "1D, 2C, 3B, 4A", "correct": false}, {"label": "C", "text": "1B, 2A, 3D, 4C", "correct": false}, {"label": "D", "text": "1C, 2D, 3B, 4A", "correct": false}], "correct_answer": "A. 1C, 2B, 3A, 4D", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - 1C, 2B, 3A, 4D\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with severe abdominal pain and elevated lipase levels. Imaging reveals a stone in the common bile duct (CBD). Which enzyme is likely to be elevated in this condition?", "options": [{"label": "A", "text": "Gamma-glutamyl transferase (GGT)", "correct": true}, {"label": "B", "text": "Lactate Dehydrogenase (LDH)", "correct": false}, {"label": "C", "text": "Alanine Aminotransferase (ALT)", "correct": false}, {"label": "D", "text": "Aspartate Aminotransferase (AST)", "correct": false}], "correct_answer": "A. Gamma-glutamyl transferase (GGT)", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Gamma-glutamyl &lt;span class=\"customMeta\" data-dictid=\"2288cbf3741692777200318d2f5b39\"&gt;transferase&lt;/span&gt; (GGT)\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A man presents with an irregularly irregular pulse and dyspnoea. What is the expected finding in the jugular venous pressure (JVP)?", "options": [{"label": "A", "text": "Absent a wave", "correct": true}, {"label": "B", "text": "Cannon a wave", "correct": false}, {"label": "C", "text": "Prominent X descent", "correct": false}, {"label": "D", "text": "Prominent Y descent", "correct": false}], "correct_answer": "A. Absent a wave", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/pwleAg8lRzuAyCcSCHCl1724909680.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An adult man presents with a protruding abdomen, diarrhea, visual disturbances and neurological manifestations. Based on the given peripheral smear, what is the most likely diagnosis?", "options": [{"label": "A", "text": "Abetalipoproteinemia", "correct": true}, {"label": "B", "text": "Whipple’s disease", "correct": false}, {"label": "C", "text": "Menetrier's Disease", "correct": false}, {"label": "D", "text": "Uremia", "correct": false}], "correct_answer": "A. Abetalipoproteinemia", "question_images": ["https://image.prepladder.com/content/ghybwnx6x9mglNRzCJPn1724852001.png"], "explanation_images": ["https://image.prepladder.com/content/4OcJHHiOvUKb6Ed3gh7d1724852049.png"], "explanation": "<p>Correct Option A – A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with fecal discharge from the umbilicus. What's the most likely diagnosis?", "options": [{"label": "A", "text": "Urachal fistula", "correct": false}, {"label": "B", "text": "Ileal diverticulum", "correct": true}, {"label": "C", "text": "Omphalocele", "correct": false}, {"label": "D", "text": "Gastroschisis", "correct": false}], "correct_answer": "B. Ileal diverticulum", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Ileal diverticulu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the most common type of congenital diaphragmatic hernia?", "options": [{"label": "A", "text": "Hiatal Hernia", "correct": false}, {"label": "B", "text": "Morgagni Hernia", "correct": false}, {"label": "C", "text": "Bochdalek Hernia", "correct": true}, {"label": "D", "text": "Umbilical Hernia", "correct": false}], "correct_answer": "C. Bochdalek Hernia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Bochdalek H\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the arrow marked nerve:", "options": [{"label": "A", "text": "Medial pectoral nerve", "correct": true}, {"label": "B", "text": "Lateral pectoral nerve", "correct": false}, {"label": "C", "text": "Long thoracic nerve", "correct": false}, {"label": "D", "text": "Thoracodorsal nerve", "correct": false}], "correct_answer": "A. Medial pectoral nerve", "question_images": ["https://image.prepladder.com/content/1VNXqBHG5TqVFLORUcpB1724927859.png"], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\"&gt;Medial&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"f991d64bc81692777195b12eec7a84\"&gt;pectoral&lt;/span&gt; nerv\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A G5P4 woman comes for her first routine sonography. She has four daughters and desires a boy this time, asking for sex determination. Based on ethical and legal guidelines, which action would you choose?", "options": [{"label": "A", "text": "Check routine ANC and sex for developmental abnormalities and do not reveal gender to the patient", "correct": false}, {"label": "B", "text": "Check routine ANC and sex for developmental abnormalities and do reveal the gender to the patient", "correct": false}, {"label": "C", "text": "Reveal the gender if it is a girl", "correct": false}, {"label": "D", "text": "Check only routine ANC; do not check the sex of the fetus", "correct": true}], "correct_answer": "D. Check only routine ANC; do not check the sex of the fetus", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Check only routine ANC; do not check the sex of the fetu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which one of the following is NOT included in Ayushman Bharat under school health services?", "options": [{"label": "A", "text": "Providing sanitary pads", "correct": false}, {"label": "B", "text": "Health check-up/screening", "correct": false}, {"label": "C", "text": "Albendazole provision", "correct": false}, {"label": "D", "text": "IFA monthly", "correct": true}], "correct_answer": "D. IFA monthly", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - IFA month\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not seen after ileal resection?", "options": [{"label": "A", "text": "Nuclear cytological asynchrony", "correct": false}, {"label": "B", "text": "Neurological manifestations", "correct": false}, {"label": "C", "text": "Microcytic hypochromic anemia", "correct": true}, {"label": "D", "text": "Reversible dementia", "correct": false}], "correct_answer": "C. Microcytic hypochromic anemia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"d09dc1da551692777192706b7f882e\"&gt;Microcytic&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"07ccd8f461169277718970a6f1a131\"&gt;hypochromic&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Based on the CT scan shown below, what is the most likely diagnosis?", "options": [{"label": "A", "text": "Renal cyst", "correct": false}, {"label": "B", "text": "Renal cell carcinoma", "correct": false}, {"label": "C", "text": "Polycystic kidney disease", "correct": true}, {"label": "D", "text": "Renal angiomyolipoma", "correct": false}], "correct_answer": "C. Polycystic kidney disease", "question_images": ["https://image.prepladder.com/content/u4a1ghb49b9PJpipscFJ1724750349.png"], "explanation_images": ["https://image.prepladder.com/content/89KoMiU7H44T4VrJwvdZ1724750513.png", "https://image.prepladder.com/content/36OWT8ta66wwywbUvNeQ1724750535.png", "https://image.prepladder.com/content/HVe4iV0e6NfGUHrWv1Gz1724847005.png"], "explanation": "<p>Correct Option C – &lt;span class=\"customMeta\" data-dictid=\"ba336eb30516927771960f9d9bd85c\"&gt;Polycystic&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\"&gt;kidney&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An absent gag reflex can result from injury to which cranial nerve?", "options": [{"label": "A", "text": "9 and 10", "correct": true}, {"label": "B", "text": "10 and 7", "correct": false}, {"label": "C", "text": "7 and 5", "correct": false}, {"label": "D", "text": "5 and 9", "correct": false}], "correct_answer": "A. 9 and 10", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - 9\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A study was undertaken to establish consumption of vegetarian and non-vegetarian diet with disease. Which statistical test should be done?", "options": [{"label": "A", "text": "Paired t-test", "correct": false}, {"label": "B", "text": "McNemar test", "correct": false}, {"label": "C", "text": "Chi-square test", "correct": true}, {"label": "D", "text": "Wilcoxon signed-rank test", "correct": false}], "correct_answer": "C. Chi-square test", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/cBsLU03pq9MUjRBgIgYp1724851311.png"], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"9560b8d7211692777184e0359e3495\"&gt;Chi-Square&lt;/span&gt; T\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the given capnograph, what does the marked area denote?", "options": [{"label": "A", "text": "Expiratory upstroke", "correct": false}, {"label": "B", "text": "Alveolar Plateau", "correct": true}, {"label": "C", "text": "Inspiratory downstroke", "correct": false}, {"label": "D", "text": "Inspiratory baseline", "correct": false}], "correct_answer": "B. Alveolar Plateau", "question_images": ["https://image.prepladder.com/content/JmOCxo5EVFnVVbzwhtcZ1724932977.png"], "explanation_images": ["https://image.prepladder.com/content/cgbcNgd6tqyIzuPwJnQx1724836473.png"], "explanation": "<p>Correct Option B – Alveolar Plateau\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A diabetic patient is advised to exercise. Which of the following glucose transporters is insulin-sensitive?", "options": [{"label": "A", "text": "GLUT4", "correct": true}, {"label": "B", "text": "GLUT1", "correct": false}, {"label": "C", "text": "GLUT3", "correct": false}, {"label": "D", "text": "GLUT2", "correct": false}], "correct_answer": "A. GLUT4", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - GLUT4\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Most common site of Congenital diaphragmatic hernia is?", "options": [{"label": "A", "text": "Central tendon", "correct": false}, {"label": "B", "text": "Posterolateral", "correct": true}, {"label": "C", "text": "Crural", "correct": false}, {"label": "D", "text": "Anterolateral", "correct": false}], "correct_answer": "B. Posterolateral", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Chelator contraindicated in Iron poisoning?", "options": [{"label": "A", "text": "Calcium disodium EDTA", "correct": false}, {"label": "B", "text": "Deferoxamine", "correct": false}, {"label": "C", "text": "British anti lewsite (BAL)", "correct": true}, {"label": "D", "text": "Penicillamine", "correct": false}], "correct_answer": "C. British anti lewsite (BAL)", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - British Anti-Lewisite (BAL)\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Post ovulation the oocyte is:", "options": [{"label": "A", "text": "Primary oocyte arrested in prophase- 1", "correct": false}, {"label": "B", "text": "Primary oocyte arrested in prophase- 2", "correct": false}, {"label": "C", "text": "Secondary oocyte arrested in prophase- 2", "correct": false}, {"label": "D", "text": "Secondary oocyte arrested in metaphase- 2", "correct": true}], "correct_answer": "D. Secondary oocyte arrested in metaphase- 2", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Secondary &lt;span class=\"customMeta\" data-dictid=\"c6c40c102d1692777194a23b2674c4\"&gt;oocyte&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"f944eef95e1692777182d5f819783f\"&gt;arrested&lt;/span&gt; in metaphase-2\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the next best step in management of a pulseless patient with the following rhythm?", "options": [{"label": "A", "text": "Defibrillate and continue chest compression", "correct": true}, {"label": "B", "text": "Defibrillate and check pulse", "correct": false}, {"label": "C", "text": "Check pulse and give synchronized DC", "correct": false}, {"label": "D", "text": "Give synchronized DC and continue chest compression", "correct": false}], "correct_answer": "A. Defibrillate and continue chest compression", "question_images": ["https://image.prepladder.com/content/Awvc5TuUfvguUnO2cg3P1724847831.png"], "explanation_images": [], "explanation": "<p>Correct Option A - Defibrillate and continue ch\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old patient undergoing treatment with Mycophenolate mofetil (MMF) presents with a serum calcium level of 13.5 mg/dL. He also has myasthenia gravis. What is the most likely cause of the hypercalcemia in this patient?", "options": [{"label": "A", "text": "Drug-induced hypercalcemia", "correct": false}, {"label": "B", "text": "Primary hyperparathyroidism", "correct": false}, {"label": "C", "text": "Small cell lung cancer", "correct": false}, {"label": "D", "text": "Thymoma", "correct": true}], "correct_answer": "D. Thymoma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Th\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In which of the following is the given position used?", "options": [{"label": "A", "text": "Neurosurgery", "correct": false}, {"label": "B", "text": "Intubation", "correct": true}, {"label": "C", "text": "NG tube insertion", "correct": false}, {"label": "D", "text": "Bougie insertion", "correct": false}], "correct_answer": "B. Intubation", "question_images": ["https://image.prepladder.com/content/vLWLiWp4io70RbVGKSoV1724836018.png"], "explanation_images": ["https://image.prepladder.com/content/lGfeCWVJG9HRK51Mmexj1724835795.png", "https://image.prepladder.com/content/CfSlrJunstBPHWh6od5o1724835813.png"], "explanation": "<p>Correct Option B – Intu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the amputation shown in the image below.", "options": [{"label": "A", "text": "Above knee amputation", "correct": false}, {"label": "B", "text": "Below knee amputation", "correct": true}, {"label": "C", "text": "Above elbow amputation", "correct": false}, {"label": "D", "text": "Syme's amputation", "correct": false}], "correct_answer": "B. Below knee amputation", "question_images": ["https://image.prepladder.com/content/PXOK4v86bwrdr4SgVwTp1724908876.png"], "explanation_images": ["https://image.prepladder.com/content/kZOpOEsF5yDdOFPiciyo1748208095.png", "https://image.prepladder.com/content/ftQhBD5mUQppFAOyH7Y41748208064.png"], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Type of Amputation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Description</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Indications</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Functionality and <span class=\"customMeta\" data-dictid=\"17d0626681169277719604432b4d27\">Prosthesis</span> Considerations</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Partial Foot Amputation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Involves the removal of part of the foot, including toes or part of the forefoot.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Severe trauma</li>\n<li>Diabetes-related complications (e.g., gangrene)</li>\n<li>Infection</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Retains some function of the foot for walking</li>\n<li>Custom <span class=\"customMeta\" data-dictid=\"ec2e1aa63016927771966c31cba210\">prostheses</span> for toes and forefoot</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Transmetatarsal <span class=\"customMeta\" data-dictid=\"9dfe4d42641692777181673eb73924\">Amputation</span> (TMA)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Amputation through the <span class=\"customMeta\" data-dictid=\"b7f1b05b6d1692777192a18bc2396f\">metatarsal</span> bones, removing the <span class=\"customMeta\" data-dictid=\"ca68a3fb831692777203e5f4094b97\">forefoot</span> but leaving the <span class=\"customMeta\" data-dictid=\"0d16a0be9416927771923ac3d80676\">midfoot</span> and <span class=\"customMeta\" data-dictid=\"985099b0c21692777189e60ac33141\">hindfoot</span> intact.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Severe foot injury</li>\n<li>Diabetes-related complications</li>\n<li>Gangrene or infection</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Often requires a <span class=\"customMeta\" data-dictid=\"17d0626681169277719604432b4d27\">prosthesis</span> that fits the <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">residual</span> part of the foot for better weight-bearing</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Lisfranc Amputation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Removal of the forefoot, including the toes and <span class=\"customMeta\" data-dictid=\"b7f1b05b6d1692777192a18bc2396f\">metatarsal</span> bones, but preserving the <span class=\"customMeta\" data-dictid=\"985099b0c21692777189e60ac33141\">hindfoot</span> and ankle.</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"336\" src=\"https://image.prepladder.com/content/kZOpOEsF5yDdOFPiciyo1748208095.png\" width=\"223\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Severe trauma</li>\n<li>Chronic infection</li>\n<li>Vascular disease</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Prosthetic options are complex due to the loss of the midfoot</li>\n<li>Often uses a custom device</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Syme’s <span class=\"customMeta\" data-dictid=\"9dfe4d42641692777181673eb73924\">Amputation</span> <strong>(Option D)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Removal of the foot at the ankle joint, with the <span class=\"customMeta\" data-dictid=\"0f66ada5d616927771898f530a8510\">heel pad</span> being preserved.</p>\n<p><img alt=\"\" data-author=\"\" data-hash=\"\" data-license=\"\" data-source=\"\" data-tags=\"\" height=\"442\" src=\"https://image.prepladder.com/content/ftQhBD5mUQppFAOyH7Y41748208064.png\" width=\"335\"/></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Trauma</li>\n<li>Severe infections</li>\n<li>Vascular disease (e.g., gangrene)</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Functional <span class=\"customMeta\" data-dictid=\"17d0626681169277719604432b4d27\">prosthesis</span> can be used, providing near-normal walking function</li>\n<li>Heel pad aids in load-bearing</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Transtibial <span class=\"customMeta\" data-dictid=\"9dfe4d42641692777181673eb73924\">Amputation</span> (Below-Knee)</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Amputation below the knee joint, typically through the <span class=\"customMeta\" data-dictid=\"ca6af868811692777200ce067e9db9\">tibia</span> and fibula.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Severe trauma</li>\n<li>Peripheral <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> disease</li>\n<li>Diabetes complications</li>\n<li>Tumors</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Functional <span class=\"customMeta\" data-dictid=\"ec2e1aa63016927771966c31cba210\">prostheses</span> (below-knee prosthesis) with ankle and foot components</li>\n<li>Retains knee function</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Knee Disarticulation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Amputation through the knee joint, preserving the <span class=\"customMeta\" data-dictid=\"512283ec9816927772024c89478b7d\">femur</span> while removing the <span class=\"customMeta\" data-dictid=\"ca6af868811692777200ce067e9db9\">tibia</span> and fibula.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Severe trauma</li>\n<li>Infection</li>\n<li>Vascular disease</li>\n<li>Bone cancer</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Prosthetic knee and foot required</li>\n<li>Retains better <span class=\"customMeta\" data-dictid=\"a459f313d9169277719789fdfb7ada\">residual</span> limb length for <span class=\"customMeta\" data-dictid=\"17d0626681169277719604432b4d27\">prosthesis</span> fitting</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Transfemoral <span class=\"customMeta\" data-dictid=\"9dfe4d42641692777181673eb73924\">Amputation</span> (Above-Knee) <strong>(Option A)</strong></p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Amputation above the knee joint, through the femur.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Severe trauma</li>\n<li>Cancer</li>\n<li>Chronic infection</li>\n<li>Peripheral <span class=\"customMeta\" data-dictid=\"526ede3fee169277720184378acc5e\">vascular</span> disease</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Requires a <span class=\"customMeta\" data-dictid=\"17d0626681169277719604432b4d27\">prosthesis</span> with both knee and ankle components</li>\n<li>More energy is required for walking</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Hip Disarticulation</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Removal of the entire leg at the hip joint, including the femur.</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Severe trauma</li>\n<li>Tumors</li>\n<li>Vascular disease</li>\n<li>Severe infection</li>\n</ul>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Prosthetic limb involves the hip joint, requires specialized sockets and joints for movement</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A woman who suffered a sunburn while enjoying a vacation on the beach now experiences pain when lukewarm water (40°C) touches her back during a shower. What types of receptors were activated by the lukewarm water, and why did she experience pain?", "options": [{"label": "A", "text": "Thermal nociceptors and nociceptive pain", "correct": false}, {"label": "B", "text": "Thermal nociceptors and allodynia", "correct": false}, {"label": "C", "text": "Innocuous thermal receptors and hyperalgesia", "correct": false}, {"label": "D", "text": "Innocuous thermal receptors and allodynia", "correct": true}], "correct_answer": "D. Innocuous thermal receptors and allodynia", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A traveler with a history of oyster consumption presents with diarrhea, abdominal pain, and vomiting. What is the most likely causative agent?", "options": [{"label": "A", "text": "S. Typhi", "correct": false}, {"label": "B", "text": "V. parahemolyticum", "correct": true}, {"label": "C", "text": "Staphylococcus", "correct": false}, {"label": "D", "text": "Cholera", "correct": false}], "correct_answer": "B. V. parahemolyticum", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/tRtFnglENCk5D2GlapbL1724839098.png"], "explanation": "<p>Correct Option B - V. Parahemolyticu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In Type 1 Diabetes Mellitus, what characterizes stage 3 of beta-cell destruction?", "options": [{"label": "A", "text": "Symptomatic hyperglycemia", "correct": true}, {"label": "B", "text": "Dysglycemic symptomatic", "correct": false}, {"label": "C", "text": "Normoglycemic symptomatic", "correct": false}, {"label": "D", "text": "Dysglycemic asymptomatic", "correct": false}], "correct_answer": "A. Symptomatic hyperglycemia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"509310d4411692777199f2ffdb7769\"&gt;Symptomatic&lt;/span&gt; hyperg\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A male patient is diagnosed with ARDS and is not responding to oxygen therapy. What is the role of IL-8 in ARDS?", "options": [{"label": "A", "text": "Endothelial cell activation", "correct": false}, {"label": "B", "text": "Neutrophil recruitment", "correct": true}, {"label": "C", "text": "Macrophage activation", "correct": false}, {"label": "D", "text": "Promotion of surfactant production", "correct": false}], "correct_answer": "B. Neutrophil recruitment", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"000d23188716927771936c5f2fe74e\"&gt;Neutrophil&lt;/span&gt; recru\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the disease associated with the image provided:", "options": [{"label": "A", "text": "Gaucher's disease", "correct": true}, {"label": "B", "text": "Tay-Sachs disease", "correct": false}, {"label": "C", "text": "Sandhoff's disease", "correct": false}, {"label": "D", "text": "Fabry's disease", "correct": false}], "correct_answer": "A. Gaucher's disease", "question_images": ["https://image.prepladder.com/content/bnbIvBMJDIKeXIGAFuoV1724850756.png"], "explanation_images": ["https://image.prepladder.com/content/MmnKBsTrBbsYsyzoXWtl1724850796.png"], "explanation": "<p>Correct Option A - Gauch\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/66whpmbiqd7FamFZ23LY1748420797.mp3", "video": ""}, {"text": "Which anticoagulant is recommended for a pregnant female at 29 weeks of gestation who develops deep vein thrombosis (DVT) with calf tenderness and is diagnosed via Doppler ultrasound?", "options": [{"label": "A", "text": "Warfarin", "correct": false}, {"label": "B", "text": "Low molecular weight heparin (LMWH)", "correct": true}, {"label": "C", "text": "Apixaban", "correct": false}, {"label": "D", "text": "Rivaroxaban", "correct": false}], "correct_answer": "B. Low molecular weight heparin (LMWH)", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Low &lt;span class=\"customMeta\" data-dictid=\"b2df2436bf1692777193d90e9c0132\"&gt;Molecular Weight&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"050e27829716927771885eddb2620c\"&gt;Heparin&lt;/span&gt; (LMWH)\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A man presented with bilateral swelling of his legs, diarrhoea, and dyspnea. He has a history of consuming mustard oil from a local vendor. Which test should be performed by the health inspector to check for the adulterant?", "options": [{"label": "A", "text": "Paper Chromatography Test", "correct": true}, {"label": "B", "text": "Nitric Acid Test", "correct": false}, {"label": "C", "text": "Methylene Blue Reduction Test", "correct": false}, {"label": "D", "text": "Both B and C", "correct": false}], "correct_answer": "A. Paper Chromatography Test", "question_images": [], "explanation_images": [], "explanation": "<table cellspacing=\"0\" style=\"border-collapse:collapse; width:624px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Clinical features</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Bilateral leg swelling, diarrhoea, dyspnoea, features of <span class=\"customMeta\" data-dictid=\"61e49875801692777188ad5edea804\">glaucoma</span> and <span class=\"customMeta\" data-dictid=\"1a5e87d16716927771888f364bce89\">heart failure</span> even up to death.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Causative agent</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p><strong>Sanguinarine (toxic <span class=\"customMeta\" data-dictid=\"46a90dd28b1692777181cae2423db7\">alkaloid</span> present in <span class=\"customMeta\" data-dictid=\"b35e0d56de1692777182df513a58b6\">argemone</span> oil).</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Detection of contamination</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li><strong>Nitric acid test:</strong> the presence of a red-brown ring when added to the sample oil indicates the presence of <span class=\"customMeta\" data-dictid=\"b35e0d56de1692777182df513a58b6\">argemone</span> oil.</li>\n<li><strong>Paper <span class=\"customMeta\" data-dictid=\"fdf5ab514d1692777184d9fe915cba\">chromatography</span> test. Most sensitive and better than <span class=\"customMeta\" data-dictid=\"5536b77611169277719356d32e638a\">nitric</span> acid test </strong><strong>(Option A)</strong><strong> (Option B ruled out)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<p>Prevention</p>\n</td>\n<td style=\"border-bottom:1px solid #000000; border-left:1px solid #000000; border-right:1px solid #000000; border-top:1px solid #000000; vertical-align:top\">\n<ul>\n<li>Accidental contamination: removing <span class=\"customMeta\" data-dictid=\"b35e0d56de1692777182df513a58b6\">argemone</span> weeds growing among oilseed crops.</li>\n<li>Deliberate contamination: enforcing Prevention of Food Adulteration Act.</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An 18-month-old child presents with hepatosplenomegaly, a hemoglobin level of 7 g/dL, a white blood cell count of 50,000 cells/cu.mm, and petechiae and purpura. What is the recommended drug treatment for this condition?", "options": [{"label": "A", "text": "Vincristine + Prednisolone", "correct": true}, {"label": "B", "text": "IVIG", "correct": false}, {"label": "C", "text": "L-Asparinigase +Prednisolone", "correct": false}, {"label": "D", "text": "Daunorubicin + Prednisolone", "correct": false}], "correct_answer": "A. Vincristine + Prednisolone", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Vincristine + P\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the procedure done.", "options": [{"label": "A", "text": "Orchidectomy", "correct": false}, {"label": "B", "text": "Total penectomy", "correct": true}, {"label": "C", "text": "Partial penectomy", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "B. Total penectomy", "question_images": ["https://image.prepladder.com/content/iZyXccPirbw2aPmVl7Wo1724839486.png"], "explanation_images": [], "explanation": "<p>Correct Option B - Total P\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with a nodular swelling near the limbus, which blanches after administering phenylephrine and then recurs. What is the most probable diagnosis?", "options": [{"label": "A", "text": "Episcleritis", "correct": true}, {"label": "B", "text": "Scleritis", "correct": false}, {"label": "C", "text": "Bitot spots", "correct": false}, {"label": "D", "text": "Pterygium", "correct": false}], "correct_answer": "A. Episcleritis", "question_images": ["https://image.prepladder.com/content/xySlXVn9LaET9V0cYGLA1724927289.png"], "explanation_images": ["https://image.prepladder.com/content/L86Fk5ZjQhNW1D0BOCu61724927527.png", "https://image.prepladder.com/content/umE9KIPW09Y5tBsDsMLP1724927373.png"], "explanation": "<p>Correct Option A – E\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is most likely based on the lab values given? Blood pH: 7.3 (indicating mild acidosis) Sodium (Na+): 134 mEq/L (mildly decreased) Potassium (K+): 2.8 mEq/L (hypokalemia) Chloride (Cl-): 113 mEq/L (elevated) Bicarbonate (HCO₃⁻): 12 mEq/L (low, indicating metabolic acidosis) Blood Urea Nitrogen (BUN): 3 mg/dL (low-normal) Creatinine: 0.6 mg/dL (normal) Urinary pH: 9.4 (alkaline)", "options": [{"label": "A", "text": "Renal Tubular Acidosis (RTA) Type 1 (Distal RTA)", "correct": true}, {"label": "B", "text": "Renal Tubular Acidosis (RTA) Type 2 (Proximal RTA)", "correct": false}, {"label": "C", "text": "Renal Tubular Acidosis (RTA) Type 4", "correct": false}, {"label": "D", "text": "High Anion Gap Metabolic Acidosis (HAGMA)", "correct": false}], "correct_answer": "A. Renal Tubular Acidosis (RTA) Type 1 (Distal RTA)", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/aPIbgtXbuRmXX7JVgpJE1724926964.png"], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"9ff00b798416927771974cced89037\"&gt;RTA&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"ebcb7136251692777201ef4b5c5718\"&gt;Type 1&lt;/span&gt; (Distal RTA)\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An infant presents with recurrent chest infections and tachypnea. Identify the likely clinical condition.", "options": [{"label": "A", "text": "Congenital Cystic Adenomatoid Malformation (CCAM)", "correct": true}, {"label": "B", "text": "Right-sided Congenital Diaphragmatic Hernia (CDH)", "correct": false}, {"label": "C", "text": "Congenital Lobar Emphysema", "correct": false}, {"label": "D", "text": "Cystic Fibrosis", "correct": false}], "correct_answer": "A. Congenital Cystic Adenomatoid Malformation (CCAM)", "question_images": ["https://image.prepladder.com/content/f49ZfrDcsDR6CX0nw7Ua1724830466.png"], "explanation_images": ["https://image.prepladder.com/content/obYTMymFY6hINWEzNM5P1724830384.png"], "explanation": "<p>Correct Option A\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the expected finding in a patient with the following CXR?", "options": [{"label": "A", "text": "Kussmaul breathing", "correct": false}, {"label": "B", "text": "Paradoxical breathing", "correct": true}, {"label": "C", "text": "Apneustic breathing", "correct": false}, {"label": "D", "text": "Bronchial breathing", "correct": false}], "correct_answer": "B. Paradoxical breathing", "question_images": ["https://image.prepladder.com/content/FEgbdCnlICIyt6ljpFFn1724847956.png"], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"5b09a1161b169277719460978e4cc1\"&gt;Paradoxical&lt;/span&gt; breathing\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Flail Chest</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Key Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Multiple rib fractures with a free-floating <span class=\"customMeta\" data-dictid=\"06e0403a9c16927771846fde1c53f8\">chest wall</span> segment, leading to <span class=\"customMeta\" data-dictid=\"5b09a1161b169277719460978e4cc1\">paradoxical</span> movement of the chest during respiration</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Expected <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> Pattern</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Paradoxical breathing: inward movement of the <span class=\"customMeta\" data-dictid=\"06e0403a9c16927771846fde1c53f8\">chest wall</span> segment during inspiration and outward during expiration</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Differential Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Differentiated from Kussmaul (metabolic acidosis), Apneustic (brainstem injury), and <span class=\"customMeta\" data-dictid=\"34dad10d7b16927771834e0d2b774a\">Bronchial breathing</span> (lung consolidation)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Rationale</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Paradoxical breathing is directly <span class=\"customMeta\" data-dictid=\"8d0fca798b1692777191b6cd41880f\">linked</span> to the loss of <span class=\"customMeta\" data-dictid=\"06e0403a9c16927771846fde1c53f8\">chest wall</span> stability due to rib fractures in <span class=\"customMeta\" data-dictid=\"3dec14fe921692777202dc55958a46\">flail</span> chest</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A hair shaft with arthroconidia is seen in the image below. Which fungi is most likely associated with this finding?", "options": [{"label": "A", "text": "Trichophyton", "correct": true}, {"label": "B", "text": "Microsporum", "correct": false}, {"label": "C", "text": "Tenia", "correct": false}, {"label": "D", "text": "Epidermophyton", "correct": false}], "correct_answer": "A. Trichophyton", "question_images": ["https://image.prepladder.com/content/5CPOhjXwnJv7Tf69mC5M1724754904.png"], "explanation_images": [], "explanation": "<p>Correct Option A - Trichoph\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The incision shown in the given image is typically performed for which of the following surgeries?", "options": [{"label": "A", "text": "Open rhinoplasty", "correct": true}, {"label": "B", "text": "Caldwell-Luc procedure", "correct": false}, {"label": "C", "text": "Septoplasty", "correct": false}, {"label": "D", "text": "Sinusotomy", "correct": false}], "correct_answer": "A. Open rhinoplasty", "question_images": ["https://image.prepladder.com/content/RTxdmaO467NhXqMTjwes1724839517.png"], "explanation_images": [], "explanation": "<p>Correct Option A - Open rh\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The period between the entry of an organism into the host and the time when the host becomes maximally infectious is referred to as?", "options": [{"label": "A", "text": "Generation time", "correct": true}, {"label": "B", "text": "Median incubation period", "correct": false}, {"label": "C", "text": "Window period", "correct": false}, {"label": "D", "text": "Latent period", "correct": false}], "correct_answer": "A. Generation time", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Tn8k0UJNgnWNSPtkoLBt1724851724.png"], "explanation": "<p>Correct Option A - G\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a pregnant woman with active genital ulcers, what is the recommended mode of delivery?", "options": [{"label": "A", "text": "LSCS (Lower Segment Caesarean Section)", "correct": true}, {"label": "B", "text": "Classic Caesarean Section", "correct": false}, {"label": "C", "text": "Vaginal Delivery", "correct": false}, {"label": "D", "text": "Induction of Labour", "correct": false}], "correct_answer": "A. LSCS (Lower Segment Caesarean Section)", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statement is correct regarding Paroxysmal Nocturnal Hemoglobinuria?", "options": [{"label": "A", "text": "Sucrose lysis test is used for confirmation", "correct": false}, {"label": "B", "text": "Flow cytometry is the best investigation", "correct": true}, {"label": "C", "text": "Most common cause of death is heart failure", "correct": false}, {"label": "D", "text": "It is an inherited disorder", "correct": false}], "correct_answer": "B. Flow cytometry is the best investigation", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Flow &lt;span class=\"customMeta\" data-dictid=\"551a62b1ec169277718587f847e627\"&gt;cytometry&lt;/span&gt; is the best investig\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following are metabolites of methanol poisoning?", "options": [{"label": "A", "text": "Formic acid + Oxalic acid", "correct": false}, {"label": "B", "text": "Formic acid + Lactic acid", "correct": true}, {"label": "C", "text": "Glycolic acid + Oxalic acid", "correct": false}, {"label": "D", "text": "Lactic acid + Glycolic acid", "correct": false}], "correct_answer": "B. Formic acid + Lactic acid", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following syndromes can lead to pulmonary hemorrhage in a patient and show p-ANCA positivity?", "options": [{"label": "A", "text": "Monckeberg's Sclerosis", "correct": false}, {"label": "B", "text": "Microscopic polyangiitis", "correct": true}, {"label": "C", "text": "Wegener granulomatosis", "correct": false}, {"label": "D", "text": "Polyarteritis nodosa", "correct": false}], "correct_answer": "B. Microscopic polyangiitis", "question_images": [], "explanation_images": [], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An adult man presents with a purulent discharge from the urethra with a history of unprotected sexual intercourse. On microscopy, gram-negative intracellular cocci are noticed. What is the drug of choice (DOC) for this patient?", "options": [{"label": "A", "text": "Tab Cefixime 400mg", "correct": true}, {"label": "B", "text": "Tab Doxycycline 200mg", "correct": false}, {"label": "C", "text": "Tab Acyclovir", "correct": false}, {"label": "D", "text": "Inj. Benzathine Penicillin", "correct": false}], "correct_answer": "A. Tab Cefixime 400mg", "question_images": ["https://image.prepladder.com/content/N3ocXCJRHhmR9gRStGyz1724838470.png"], "explanation_images": [], "explanation": "<p>Correct Option A - Tab &lt;span class=\"customMeta\" data-dictid=\"94fbaea7e01692777184df55664d5f\"&gt;Cefixime&lt;/span&gt; 400mg\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 210 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">
<div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-xl font-semibold mb-4">Instructions</h2> <h4 class="text-gray-800 text-lg font-semibold mt-6 mb-4">Test Features:</h4> <ul class="space-y-3"> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Multiple choice questions with single correct answers </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Timer-based testing for realistic exam conditions </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mark questions for review functionality </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Comprehensive results and performance analysis </li> <li class="flex items-center gap-3"> <i class="fa-solid fa-circle-check text-green-500"></i> Mobile-optimized interface for learning on-the-go </li> </ul> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="start-test">Start Test</button> </div> <div class="error-message hidden" id="error-message"></div> </div> </section> <!-- Quiz Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="quiz"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <!-- Progress Bar --> <div class="w-full bg-gray-200 rounded-full h-3 mb-4"> <div class="progress-bar h-3 rounded-full" id="progress-bar" style="width: 0%"></div> </div> <!-- Question Header --> <div class="flex flex-col md:flex-row justify-between items-center mb-4"> <h2 class="text-lg font-semibold" id="question-number">Question <span>1</span> of 4</h2> <p class="text-lg font-semibold mt-2 md:mt-0" id="timer">Time Remaining: <span>00:00</span></p> </div> <!-- Question Content --> <div class="mb-6" id="question-content"> <p class="text-gray-800 mb-4" id="question-text"></p> <div class="flex flex-wrap gap-4 mb-4" id="question-images"></div> <div class="space-y-3" id="options"></div> </div> <!-- Navigation Buttons --> <div class="flex flex-col md:flex-row justify-between items-center gap-2 md:gap-4"> <div class="flex gap-2 w-full md:w-auto"> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="previous-btn">Previous</button> <button class="bg-[#2c5281] text-white px-4 py-3 w-full md:w-32 h-14 rounded-lg hover:bg-[#2c5281] transition" id="next-btn">Next</button> </div> <div class="flex items-center gap-2"> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="mark-review"> Review <svg xmlns="http://www.w3.org/2000/svg" class="h-5 w-5" viewBox="0 0 20 20" fill="currentColor"> <path d="M10 2a1 1 0 00-1 1v14l3.293-3.293a1 1 0 011.414 0L17 17V3a1 1 0 00-1-1H10z" /> </svg> </button> <button class="bg-transparent text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-100 transition flex items-center gap-1" id="nav-toggle"> Question 🧭 </button> <button class="bg-green-500 text-white px-6 py-3 w-44 h-14 rounded-lg hover:bg-green-600 transition w-full md:w-auto" id="submit-test">Submit Test</button> </div> </div> </section> <!-- Results Section --> <section class="container mx-auto px-4 md:px-6 pt-4 md:pt-6 pb-1 hidden section-transition" id="results"> <div class="bg-white rounded-lg shadow-md p-4 md:p-6"> <h2 class="text-2xl font-semibold mb-4">Anaesthesia Machine - Results</h2> <div class="grid grid-cols-1 md:grid-cols-2 gap-4 mb-6"> <p><strong>Correct:</strong> <span id="correct-count" class="text-[#000000]">0</span></p> <p><strong>Wrong:</strong> <span id="wrong-count" class="text-[#000000]">0</span></p> <p><strong>Unanswered:</strong> <span id="unanswered-count" class="text-[#000000]-500">0</span></p> <p><strong>Marked for Review:</strong> <span id="marked-count" class="text-[#000000]">0</span></p> </div> <h3 class="text-lg font-semibold mb-4" id="result-question-number">Question <span>1</span> of 4</h3> <div class="space-y-6" id="results-content"></div> <div class="result-nav"> <button aria-label="Previous question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" disabled="" id="prev-result">Previous</button> <button aria-label="Toggle results navigation panel" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="results-nav-toggle">Result 🧭</button> <button aria-label="Next question result" class="result-nav-btn bg-[#2c5281] text-white px-6 py-2 rounded-lg hover:bg-[#2c5281] transition" id="next-result">Next</button> </div> <div class="mt-6 flex space-x-4 button-group md:flex-row flex-col"> <button class="bg-green-500 text-white px-6 py-2 rounded-lg hover:bg-green-600 transition" id="take-again">Take Again</button> </div> </div> </section> <!-- Exit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="exit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Leave Test?</h2> <p class="text-gray-700 mb-4">Your progress will be lost if you leave this page. Are you sure you want to exit?</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="continue-test">No, Continue</button> <button class="bg-red-500 text-white px-4 py-2 rounded-lg hover:bg-red-600 transition" id="exit-test">Yes, Exit</button> </div> </div> </div> <!-- Submit Confirmation Modal --> <div class="fixed inset-0 bg-black bg-opacity-50 flex items-center justify-center hidden" id="submit-modal"> <div class="bg-white rounded-lg p-6 max-w-sm w-full"> <h2 class="text-xl font-semibold mb-4">Confirm Submission</h2> <p class="text-gray-700 mb-2">You have attempted <span id="attempted-count">0</span> of 200 questions.</p> <p class="text-gray-700 mb-4"><span id="unattempted-count">0</span> questions are unattempted.</p> <div class="flex justify-end space-x-4"> <button class="bg-gray-300 text-gray-700 px-4 py-2 rounded-lg hover:bg-gray-400 transition" id="cancel-submit">Cancel</button> <button class="bg-green-500 text-white px-4 py-2 rounded-lg hover:bg-green-600 transition" id="confirm-submit">Submit Test</button> </div> </div> </div> <!-- Quiz Navigation Panel --> <div class="fixed inset-y-0 right-0 nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="nav-panel"> <h2 class="text-lg font-semibold mb-4">Questions Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-nav">Close</button> </div> <!-- Results Navigation Panel --> <div class="fixed inset-y-0 right-0 results-nav-panel bg-white shadow-lg p-4 hidden overflow-y-auto" id="results-nav-panel"> <h2 class="text-lg font-semibold mb-4">Results Navigation</h2> <div class="mb-4"> <select class="w-full p-2 border rounded-lg text-gray-700" id="results-nav-filter"> <option value="all">All Questions</option> <option value="answered">Answered</option> <option value="unanswered">Unanswered</option> <option value="marked">Marked for Review</option> </select> </div> <div class="grid grid-cols-5 gap-2 md:gap-3" id="results-nav-grid"></div> <button class="mt-4 bg-gray-500 text-white px-4 py-2 rounded-lg hover:bg-gray-600 transition w-full" id="close-results-nav">Close</button> </div> <!-- JavaScript Logic --> <script> // Enable debug mode for detailed logging const DEBUG_MODE = true; // Log debug messages function debugLog(message) { if (DEBUG_MODE) { console.log(`[DEBUG] ${message}`); } } // Initialize questions with error handling let questions = []; let currentResultQuestion = 0; // State for current question in results try { debugLog("Attempting to parse questions_json"); questions = [{"text": "The flexion point in a ventouse delivery is located at which of the following positions on the fetal head?", "options": [{"label": "A", "text": "3 cm posterior to the anterior fontanelle", "correct": false}, {"label": "B", "text": "3 cm anterior to the posterior fontanelle", "correct": true}, {"label": "C", "text": "6 cm anterior to the posterior fontanelle", "correct": false}, {"label": "D", "text": "Midway between the anterior and posterior fontanelle", "correct": false}], "correct_answer": "B. 3 cm anterior to the posterior fontanelle", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - 3 cm &lt;span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\"&gt;anterior&lt;/span&gt; to the &lt;span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\"&gt;posterior&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is incorrect regarding Samter's triad?", "options": [{"label": "A", "text": "It is only triggered by aspirin.", "correct": true}, {"label": "B", "text": "Other NSAIDs with COX-1 blocking ability can also trigger symptoms.", "correct": false}, {"label": "C", "text": "It is characterized by asthma, nasal polyps, and aspirin sensitivity.", "correct": false}, {"label": "D", "text": "It involves overproduction of leukotrienes.", "correct": false}], "correct_answer": "A. It is only triggered by aspirin.", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - \n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\">\n<p><strong>Other Name</strong></p>\n</td>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\">\n<p>Aspirin-Exacerbated <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">Respiratory</span> Disease (AERD)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\"><strong>Key Characteristics</strong></td>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\">\n<ul>\n<li>Asthma</li>\n<li>Nasal polyps</li>\n<li>Sensitivity to <span class=\"customMeta\" data-dictid=\"deba671f4716927771828c95a320e5\">aspirin</span> and other NSAIDs with COX-1 inhibition</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\"><strong>Triggering Agents</strong></td>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\">Aspirin and other NSAIDs that <span class=\"customMeta\" data-dictid=\"6b3de87b7c16927771901326efbcd2\">inhibit</span> COX-1, such as <span class=\"customMeta\" data-dictid=\"5778d7dc361692777189571125f0bd\">ibuprofen</span> and naproxen</td>\n</tr>\n<tr>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\"><strong>Pathophysiology</strong></td>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\">Overproduction of leukotrienes due to the <span class=\"customMeta\" data-dictid=\"f03ca2d2a716927771901227bc175a\">inhibition</span> of COX-1, leading to <span class=\"customMeta\" data-dictid=\"e747a47db616927771908bff4b8931\">inflammation</span> and <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> symptoms</td>\n</tr>\n<tr>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\"><strong>Common Symptoms</strong></td>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\">\n<ul>\n<li>Worsening of asthma</li>\n<li>Nasal <span class=\"customMeta\" data-dictid=\"2dd9736fdf16927771849f5a925f7d\">congestion</span> and sinusitis</li>\n<li>Recurrence of <span class=\"customMeta\" data-dictid=\"31c5d0e75f16927771938d8e2daa4c\">nasal</span> polyps</li>\n<li>Respiratory <span class=\"customMeta\" data-dictid=\"afafb9026e1692777186e3dd168fa8\">distress</span> after <span class=\"customMeta\" data-dictid=\"b924074dfe16927771933b6d50eaac\">NSAID</span> ingestion</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\"><strong>Management</strong></td>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\">\n<ul>\n<li>Avoidance of <span class=\"customMeta\" data-dictid=\"deba671f4716927771828c95a320e5\">aspirin</span> and COX-1 inhibiting NSAIDs</li>\n<li>Leukotriene <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antagonists (e.g., montelukast)</li>\n<li>Desensitization therapy</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Sour taste is perceived by which receptors?", "options": [{"label": "A", "text": "T1R1", "correct": false}, {"label": "B", "text": "T1R2", "correct": false}, {"label": "C", "text": "T1R3", "correct": false}, {"label": "D", "text": "TRPP3", "correct": true}], "correct_answer": "D. TRPP3", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/o10BCKK6cld0j1BxGRtx1724905387.png"], "explanation": "<p>Correct Option D - TRPP3\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What instrument is used to insert this tube?", "options": [{"label": "A", "text": "Nephroscope", "correct": false}, {"label": "B", "text": "Cysto urethroscope", "correct": true}, {"label": "C", "text": "Ureteroscope", "correct": false}, {"label": "D", "text": "Endoscope", "correct": false}], "correct_answer": "B. Cysto urethroscope", "question_images": ["https://image.prepladder.com/content/STTQzU5WKvGpVBgvSIcZ1724928610.png"], "explanation_images": [], "explanation": "<p>Correct Option B - Cysto-ureth\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 13-year-old boy presents with jaundice, fatigue, muscle stiffness, tremors, behavioral changes, hepatosplenomegaly, and Kayser-Fleischer rings. Which test is definitive for the diagnosis?", "options": [{"label": "A", "text": "Urinary copper", "correct": false}, {"label": "B", "text": "Serum ceruloplasmin", "correct": true}, {"label": "C", "text": "Hepatic parenchymal copper concentration", "correct": false}, {"label": "D", "text": "Genetic testing for ATP7B mutation", "correct": false}], "correct_answer": "B. Serum ceruloplasmin", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/xmjE7051KErEKf8I1T5k1747657700.png"], "explanation": "<table cellspacing=\"0\">\n<tbody>\n<tr>\n<td>\n<p><strong>Aspect</strong></p>\n</td>\n<td>\n<p><strong>Details</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Definition</strong></p>\n</td>\n<td>\n<p>Autosomal <span class=\"customMeta\" data-dictid=\"d54db2110416927771971e7c011a9f\">recessive</span> disorder of <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> <span class=\"customMeta\" data-dictid=\"5b1a045f5f169277719210c0ac7a1e\">metabolism</span> leading to <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> accumulation in tissues.</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Gene Affected</strong></p>\n</td>\n<td>\n<p><strong>ATP7B</strong> gene <span class=\"customMeta\" data-dictid=\"7a67bdf6f81692777193cfd480f228\">mutation</span> on <span class=\"customMeta\" data-dictid=\"7157c1f59916927771846116d74646\">chromosome</span> 13.<strong>(Option D)</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td>\n<ul>\n<li>Defective <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> transport leads to:</li>\n<li>Decreased <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> <span class=\"customMeta\" data-dictid=\"7bc107ea09169277719095466ee864\">incorporation</span> into ceruloplasmin.</li>\n<li>Impaired <span class=\"customMeta\" data-dictid=\"7dd6eda7ce169277718325f22de9e8\">biliary</span> <span class=\"customMeta\" data-dictid=\"0f7653c9ef1692777187deaa35f749\">excretion</span> of copper.</li>\n<li>Copper accumulates in the liver, spills into the bloodstream, and deposits in various tissues.</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\">\n<p><strong>Clinical Features</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Hepatic</strong></p>\n</td>\n<td>\n<ul>\n<li>Acute hepatitis</li>\n<li>Chronic liver disease (cirrhosis)</li>\n<li>Fulminant <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> failure</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Neurological</strong></p>\n</td>\n<td>\n<ul>\n<li>Dysarthria</li>\n<li>Movement disorders (tremors, dystonia, chorea)</li>\n<li>Rigidity, bradykinesia</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Psychiatric</strong></p>\n</td>\n<td>\n<ul>\n<li>Depression, irritability, or psychosis</li>\n<li>Cognitive decline</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Ophthalmological</strong></p>\n</td>\n<td>\n<ul>\n<li><strong>Kayser-Fleischer rings</strong> (golden-brown ring at the corneal margin due to <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> deposition) in <span class=\"customMeta\" data-dictid=\"7fbb9ec5b716927771981c011f4299\">slit</span> lamp examination <strong>(Option D)</strong></li>\n<li>Sunflower cataracts (less common)</li>\n</ul>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\">\n<p><strong>Diagnosis</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Biochemical</strong></p>\n</td>\n<td>\n<ul>\n<li><strong>Gold standard: Elevated <span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\">hepatic</span> <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> content on liver <span class=\"customMeta\" data-dictid=\"754ab07a2e1692777183ed178c883d\">biopsy</span> (&gt;250 µg/g dry weight) </strong><strong>(Option C)</strong></li>\n<li>Low <span class=\"customMeta\" data-dictid=\"1ffaec13de169277719828374cfda0\">serum</span> <span class=\"customMeta\" data-dictid=\"d0297935661692777184085cf7e86f\">ceruloplasmin</span> (&lt;20 mg/dL) <strong>(Option B)</strong></li>\n<li>Elevated 24-hour <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> <span class=\"customMeta\" data-dictid=\"0f7653c9ef1692777187deaa35f749\">excretion</span> (&gt;100 µg/day) <strong>(Option A)</strong></li>\n</ul>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Imaging</strong></p>\n</td>\n<td>\n<p>Brain MRI: Hyperintensities in <span class=\"customMeta\" data-dictid=\"923af580cf16927771829606bce2a7\">basal</span> <span class=\"customMeta\" data-dictid=\"f2804c808516927771887dda93e56c\">ganglia</span> (e.g., \"face of the giant panda\" sign in the midbrain)</p>\n</td>\n</tr>\n<tr>\n<td colspan=\"2\">\n<p><strong>Treatment</strong></p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Copper Chelation</strong></p>\n</td>\n<td>\n<p><strong>D-Penicillamine</strong> (binds and increases <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> excretion)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Copper <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">Absorption</span> Blockers</strong></p>\n</td>\n<td>\n<p><strong>Zinc salts</strong>: Compete with <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> <span class=\"customMeta\" data-dictid=\"5fcb9396d1169277718069dd7fa788\">absorption</span> in the gut</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Dietary</strong></p>\n</td>\n<td>\n<p>Low-copper diet (avoid shellfish, nuts, chocolate, liver)</p>\n</td>\n</tr>\n<tr>\n<td>\n<p><strong>Liver Transplant</strong></p>\n</td>\n<td>\n<p>For severe liver failure or unresponsive cases</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A singer is finding difficulty in raising the pitch of her voice. On examination, her vocal cords were depressed and bowing. Which of the following muscles is involved?", "options": [{"label": "A", "text": "Cricothyroid", "correct": true}, {"label": "B", "text": "Interarytenoid", "correct": false}, {"label": "C", "text": "Posterior cricoarytenoid", "correct": false}, {"label": "D", "text": "Lateral arytenoid", "correct": false}], "correct_answer": "A. Cricothyroid", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/cxe33Y09Y72fD22rPHeu1724839745.png"], "explanation": "<p>Correct Option A - Cricoth\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with fever, hepatosplenomegaly, abdominal pain, and WBC count &amp;gt; 50,000/mm 3 . Which of the following genetic abnormalities is involved?", "options": [{"label": "A", "text": "t(9;22)", "correct": true}, {"label": "B", "text": "del(1q)", "correct": false}, {"label": "C", "text": "t(15;17)", "correct": false}, {"label": "D", "text": "del 3q", "correct": false}], "correct_answer": "A. t(9;22)", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - t(9;22)\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td><strong>CML </strong></td>\n<td><strong>Characteristics </strong></td>\n</tr>\n<tr>\n<td>t(9:22)</td>\n<td>Cause </td>\n</tr>\n<tr>\n<td>Massive Spleen </td>\n<td>Spleen </td>\n</tr>\n<tr>\n<td>High </td>\n<td>TLC </td>\n</tr>\n<tr>\n<td>&gt;20% Acc</td>\n<td>Basophils </td>\n</tr>\n<tr>\n<td>Decreased </td>\n<td>LAP score </td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A fruit farmer presents with fever, respiratory difficulties, and neurological complications. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Ebola", "correct": false}, {"label": "B", "text": "Meningitis", "correct": false}, {"label": "C", "text": "Nipah", "correct": true}, {"label": "D", "text": "Zika", "correct": false}], "correct_answer": "C. Nipah", "question_images": ["https://image.prepladder.com/content/3ekWcDI2wQWFA3vKGl221724843053.png"], "explanation_images": ["https://image.prepladder.com/content/j0HhZmXpZpLHuCQWpeOU1724843070.png"], "explanation": "<p>Correct Option C - Nipah\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following vaccine is kept at lowest level?", "options": [{"label": "A", "text": "OPV", "correct": true}, {"label": "B", "text": "DPT", "correct": false}, {"label": "C", "text": "Hep B", "correct": false}, {"label": "D", "text": "Rota", "correct": false}], "correct_answer": "A. OPV", "question_images": ["https://image.prepladder.com/content/zybjgrgOwfw10yM13PEn1724851062.PNG"], "explanation_images": ["https://image.prepladder.com/content/e3lRci92ucBetr2GnrWJ1724851113.png", "https://image.prepladder.com/content/OZuNGi8rXJ61m48lC1af1724851135.png"], "explanation": "<p>Correct Option A - OPV\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A mother delivers in a rural area under the guidance of a skilled care attendant. Which of the following is incorrect regarding the care provided by the skilled care attendant at birth?", "options": [{"label": "A", "text": "Start breastfeeding as early as possible", "correct": false}, {"label": "B", "text": "Cover the baby's head and body", "correct": false}, {"label": "C", "text": "Bathe the baby with warm water", "correct": true}, {"label": "D", "text": "Clear eyes with a sterile swab", "correct": false}], "correct_answer": "C. Bathe the baby with warm water", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Bathe the baby with\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the ideal pressure setting for vacuum-assisted closure (VAC) therapy?", "options": [{"label": "A", "text": "-125 mm Hg", "correct": true}, {"label": "B", "text": "60 to 80 mm Hg", "correct": false}, {"label": "C", "text": "130 mm Hg", "correct": false}, {"label": "D", "text": "80 to 100 mm Hg", "correct": false}], "correct_answer": "A. -125 mm Hg", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - 125 mm Hg\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An infant presents with vomiting after feeding. A Benedict’s test was performed and returned positive for a non-glucose substance. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Galactosemia due to GAL-1-P uridyl transferase enzyme deficiency", "correct": true}, {"label": "B", "text": "Hereditary fructose intolerance due to aldolase B deficiency", "correct": false}, {"label": "C", "text": "Glucose-6-Phosphate dehydrogenase (G6PD) deficiency", "correct": false}, {"label": "D", "text": "Galactosemia due to galactokinase enzyme deficiency", "correct": false}], "correct_answer": "A. Galactosemia due to GAL-1-P uridyl transferase enzyme deficiency", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"a62cd844a916927771883fd1e691f5\"&gt;Galactosemia&lt;/span&gt; due to GAL-1-P uridyl &lt;span class=\"customMeta\" data-dictid=\"2288cbf3741692777200318d2f5b39\"&gt;transferase&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"0f160e4e42169277718771b715516a\"&gt;enzyme&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the instrument shown below:", "options": [{"label": "A", "text": "Kielland", "correct": false}, {"label": "B", "text": "Wrigley", "correct": false}, {"label": "C", "text": "Pipers", "correct": true}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "C. Pipers", "question_images": ["https://image.prepladder.com/content/iOtm8AWFSbjzdIDdJeWq1724760408.png"], "explanation_images": ["https://image.prepladder.com/content/XFzXvsmOsV9sMIZVCM8K1724760518.png"], "explanation": "<p>Correct Option C – P\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What does JSSK stand for?", "options": [{"label": "A", "text": "Janani Shishu Suraksha Karyakram", "correct": true}, {"label": "B", "text": "Janani Shishu Swasthya Karyakram", "correct": false}, {"label": "C", "text": "Janani Shishu Suraksha Kendra]", "correct": false}, {"label": "D", "text": "Janani Shishu Swasthya Kendra", "correct": false}], "correct_answer": "A. Janani Shishu Suraksha Karyakram", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/BQjE3oNwIjJ7mdbwJBcN1724850034.png"], "explanation": "<p>Correct Option A - Janani Shishu Suraksha Karyak\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 12-year-old child presents to the outpatient department (OPD) with a complaint of scrotal pain, with a history of trauma 6 hours prior. Upon surgical exploration, the findings suggest significant damage. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Testicular torsion with gangrene", "correct": true}, {"label": "B", "text": "Torsion of testicular appendages with gangrene", "correct": false}, {"label": "C", "text": "Gangrene", "correct": false}, {"label": "D", "text": "Hematoma", "correct": false}], "correct_answer": "A. Testicular torsion with gangrene", "question_images": ["https://image.prepladder.com/content/LH2OUQ2ZmjQB38aBPJm01724838936.png"], "explanation_images": ["https://image.prepladder.com/content/iGmoopopIJya7XTG1MSH1724908799.png", "https://image.prepladder.com/content/sD2cywLy0oTV1FGuxc491724908808.png", "https://image.prepladder.com/content/phm5UetPk04eC7LppV371724908822.png"], "explanation": "<p>Correct Option A - Testicular &lt;span class=\"customMeta\" data-dictid=\"49c306e91e1692777200be46fecf66\"&gt;torsion&lt;/span&gt; with gang\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with painful vesicles in the genital region. Identify the lesion shown in the image and choose the correct diagnosis:", "options": [{"label": "A", "text": "Herpes", "correct": true}, {"label": "B", "text": "Chancroid", "correct": false}, {"label": "C", "text": "Syphilis", "correct": false}, {"label": "D", "text": "Candidiasis", "correct": false}], "correct_answer": "A. Herpes", "question_images": ["https://image.prepladder.com/content/qWtALq909kDwgljfyYR81724837058.png"], "explanation_images": ["https://image.prepladder.com/content/EB8fSwCooVJjGKsw6pyZ1724837131.png"], "explanation": "<p>Correct Option A - H\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which neonatal anomaly is depicted in the image?", "options": [{"label": "A", "text": "Omphalocele", "correct": false}, {"label": "B", "text": "Gastroschisis", "correct": false}, {"label": "C", "text": "Patent vitello intestinal duct", "correct": false}, {"label": "D", "text": "Exstrophy bladder", "correct": true}], "correct_answer": "D. Exstrophy bladder", "question_images": ["https://image.prepladder.com/content/u8S9D0YnMsL6TET9MI4k1724844262.png"], "explanation_images": [], "explanation": "<p>Correct Option D\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with xanthomas on the Achilles tendon. Which of the following is the most likely diagnosis?", "options": [{"label": "A", "text": "Familial hypercholesterolemia", "correct": true}, {"label": "B", "text": "Tangier disease", "correct": false}, {"label": "C", "text": "Familial hyperchylomicronemia", "correct": false}, {"label": "D", "text": "Type III hyperlipoproteinemia", "correct": false}], "correct_answer": "A. Familial hypercholesterolemia", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/PBj7YaR6ErNYLB7Z4p7C1724848586.png", "https://image.prepladder.com/content/mL2zGMXSXQxhr4YbtylK1724848601.png", "https://image.prepladder.com/content/ddqPY8ZARbEbZltn1hLe1724848611.png"], "explanation": "<p>Correct Option A - Familial hyperch\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Patient is having a headache and confusion. A brain tumor diagnosis is made. Family history reveals brain and kidney tumors. Choose the correct option:", "options": [{"label": "A", "text": "Neurofibromatosis", "correct": false}, {"label": "B", "text": "Li fraumeni syndrome", "correct": false}, {"label": "C", "text": "VHL Syndrome", "correct": true}, {"label": "D", "text": "Churg strauss syndrome", "correct": false}], "correct_answer": "C. VHL Syndrome", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - VHL\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>VHL syndrome</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Key Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Brain tumors (hemangioblastomas), <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> tumors (renal cell carcinoma), pheochromocytomas</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Confirmed by genetic testing for VHL gene mutations and <span class=\"customMeta\" data-dictid=\"fe3220767716927771892419444041\">imaging</span> studies for tumors</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Distinguishing Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Presence of both brain and <span class=\"customMeta\" data-dictid=\"4aa6035df41692777190b41d4a1583\">kidney</span> tumors aligns with VHL syndrome</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A man presents with back pain following road traffic accident. There was no history of neurological deficit. X ray spine is done. What is the diagnosis?", "options": [{"label": "A", "text": "Spinous process fracture", "correct": true}, {"label": "B", "text": "Chance fracture", "correct": false}, {"label": "C", "text": "Fracture o base of vertebrae", "correct": false}, {"label": "D", "text": "Compressed fracture", "correct": false}], "correct_answer": "A. Spinous process fracture", "question_images": ["https://image.prepladder.com/content/AtttNjIFxbsJq56NhP141724757430.png"], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"6ecc9fc8e416927771993c575ccc1e\"&gt;Spinous&lt;/span&gt; Process Fractu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child presents with growth failure. Biochemical analysis shows normal ca2+, normal PTH, reduced phosphate, and increased ALP. What is the diagnosis?", "options": [{"label": "A", "text": "Nutritional rickets", "correct": false}, {"label": "B", "text": "Hypophosphatemic rickets", "correct": true}, {"label": "C", "text": "Type 1 VDDR", "correct": false}, {"label": "D", "text": "Type 2 VDDR", "correct": false}], "correct_answer": "B. Hypophosphatemic rickets", "question_images": ["https://image.prepladder.com/content/3gmzZKRy4mF5B4X5Nhho1724756905.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents to the outpatient department with an ulcerated breast tumor and liver metastasis. What is the appropriate management?", "options": [{"label": "A", "text": "Simple mastectomy", "correct": false}, {"label": "B", "text": "Modified Radical Mastectomy (MRM)", "correct": false}, {"label": "C", "text": "Radical mastectomy", "correct": false}, {"label": "D", "text": "Neoadjuvant chemotherapy followed by surgery", "correct": true}], "correct_answer": "D. Neoadjuvant chemotherapy followed by surgery", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Neoadjuvant &lt;span class=\"customMeta\" data-dictid=\"8602c4b260169277718439bb122cb0\"&gt;chemotherapy&lt;/span&gt; followed by surg\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the disease?", "options": [{"label": "A", "text": "Renal cyst", "correct": true}, {"label": "B", "text": "Renal tumor", "correct": false}, {"label": "C", "text": "ADPKD", "correct": false}, {"label": "D", "text": "Hydatid cyst", "correct": false}], "correct_answer": "A. Renal cyst", "question_images": ["https://image.prepladder.com/content/nrgGfTNGuzD9EyAesM771724910015.png"], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"b9356afdba16927771979d068c6587\"&gt;Renal&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old woman is diagnosed with right vestibular neuronitis. What findings are expected during the head impulse test in this patient?", "options": [{"label": "A", "text": "When the head is turned to the left, the eyeballs move to the left with nystagmus.", "correct": false}, {"label": "B", "text": "When the head is turned to the left, the eyeballs move to the right with nystagmus.", "correct": false}, {"label": "C", "text": "When the head is turned to the right, the eyeballs move to the left with nystagmus.", "correct": true}, {"label": "D", "text": "When the head is turned to the right, the eyeballs move to the right with nystagmus.", "correct": false}], "correct_answer": "C. When the head is turned to the right, the eyeballs move to the left with nystagmus.", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/w1Dd85kPawoLtEv9nt7o1724840783.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the anticoagulation of choice for a pregnant female at 36 weeks of gestation?", "options": [{"label": "A", "text": "Warfarin", "correct": false}, {"label": "B", "text": "Heparin", "correct": true}, {"label": "C", "text": "Apixaban", "correct": false}, {"label": "D", "text": "Enoxaparin", "correct": false}], "correct_answer": "B. Heparin", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - H\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient does not understand the meaning of the doctor's words. Which type of barrier is this?", "options": [{"label": "A", "text": "Cultural", "correct": false}, {"label": "B", "text": "Linguistic", "correct": true}, {"label": "C", "text": "Psychological", "correct": false}, {"label": "D", "text": "Environmental", "correct": false}], "correct_answer": "B. Linguistic", "question_images": [], "explanation_images": [], "explanation": "<table>\n<thead>\n<tr>\n<th><strong>Type</strong></th>\n<th><strong>Description</strong></th>\n<th><strong>Example</strong></th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td><strong>Cultural</strong></td>\n<td>Differences in beliefs, values, or customs</td>\n<td>A patient rejecting treatment due to cultural beliefs</td>\n</tr>\n<tr>\n<td><strong>Linguistic</strong></td>\n<td>Barriers related to language or word usage</td>\n<td>A patient not understanding medical terminology</td>\n</tr>\n<tr>\n<td><strong>Psychological</strong></td>\n<td>Related to emotions, stress, anxiety, or mental health</td>\n<td>A patient too anxious to listen or comprehend</td>\n</tr>\n<tr>\n<td><strong>Environmental</strong></td>\n<td>Due to external distractions like noise, poor lighting, or space</td>\n<td>A <span class=\"customMeta\" data-dictid=\"61d68435aa1692777185d5e4ccda1d\">consultation</span> held in a noisy hospital corridor</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A football player had a twist in the ankle and knee. Clinically, no bony injury was appreciated. The examiner is performing a test to assess the knee joint. Which test is this?", "options": [{"label": "A", "text": "Posterior drawer for PCL", "correct": false}, {"label": "B", "text": "Mc Murray", "correct": false}, {"label": "C", "text": "Lachman", "correct": true}, {"label": "D", "text": "Anterior drawer for ACL", "correct": false}], "correct_answer": "C. Lachman", "question_images": ["https://image.prepladder.com/content/f8BRzTDBAaw98foC8RvD1724837997.png"], "explanation_images": [], "explanation": "<p>Correct Option C\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which drug is used in the maintenance phase of opioid withdrawal?", "options": [{"label": "A", "text": "Buprenorphine", "correct": true}, {"label": "B", "text": "Disulfiram", "correct": false}, {"label": "C", "text": "Butorphanol", "correct": false}, {"label": "D", "text": "Clonidine", "correct": false}], "correct_answer": "A. Buprenorphine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A – Buprenorph\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Aprepitant, a drug used to prevent late-onset chemotherapy-induced nausea and vomiting, acts through which of the following mechanisms?", "options": [{"label": "A", "text": "NK-1 antagonist", "correct": true}, {"label": "B", "text": "NK-1 agonist", "correct": false}, {"label": "C", "text": "NK-3 antagonist", "correct": false}, {"label": "D", "text": "NK-2 antagonist", "correct": false}], "correct_answer": "A. NK-1 antagonist", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - NK-1 Antag\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the logo?", "options": [{"label": "A", "text": "Leprosy", "correct": true}, {"label": "B", "text": "TB", "correct": false}, {"label": "C", "text": "Malaria", "correct": false}, {"label": "D", "text": "HIV", "correct": false}], "correct_answer": "A. Leprosy", "question_images": ["https://image.prepladder.com/content/b8jiZ3ZL69L0VxO4nccK1724850066.png"], "explanation_images": ["https://image.prepladder.com/content/MFmMPX5TU4NRzuosEPs51724850086.png"], "explanation": "<p>Correct Option A - L\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old woman presents with a long-standing history of “feeling tensed” along with an upset stomach, diarrhea, and heartburn. She mentions that her family members also experience similar symptoms. Which of the following symptoms is most likely to be observed in this patient?", "options": [{"label": "A", "text": "Neologisms", "correct": false}, {"label": "B", "text": "Tingling at extremities", "correct": true}, {"label": "C", "text": "Hallucinations", "correct": false}, {"label": "D", "text": "Idea of reference", "correct": false}], "correct_answer": "B. Tingling at extremities", "question_images": [], "explanation_images": [], "explanation": "<p><strong>References:</strong></p>\n<ul><li>↳ The patient has a long-standing history of tension (anxiety), gastrointestinal symptoms (upset stomach, diarrhea, heartburn), and a family history of similar symptoms. This suggests a diagnosis of anxiety-related disorder or somatization with physical manifestations.</li><li>↳ The patient has a long-standing history of tension (anxiety), gastrointestinal symptoms (upset stomach, diarrhea, heartburn), and a family history of similar symptoms. This suggests a diagnosis of anxiety-related disorder or somatization with physical manifestations.</li><li>↳ anxiety-related disorder or somatization</li><li>↳ Tingling at extremities (paresthesia) is a common somatic symptom associated with anxiety or panic disorder.</li><li>↳ Tingling at extremities (paresthesia) is a common somatic symptom associated with anxiety or panic disorder.</li><li>↳ Neologisms and hallucinations are features of psychotic disorders, which are not suggested here.</li><li>↳ Neologisms and hallucinations are features of psychotic disorders, which are not suggested here.</li><li>↳ Idea of reference is a delusional symptom seen in schizophrenia or related psychotic disorders, which is unlikely given the presentation.</li><li>↳ Idea of reference is a delusional symptom seen in schizophrenia or related psychotic disorders, which is unlikely given the presentation.</li><li>↳ Symptom Association Explanation Tingling at extremities Anxiety and somatic symptoms Common physical manifestation of anxiety or hyperventilation Neologisms Psychotic disorders (schizophrenia) Not typical in anxiety or somatic symptom disorders Hallucinations Psychotic disorders Not present in anxiety disorders Idea of reference Delusional symptom in schizophrenia Not consistent with anxiety or somatic complaints</li><li>↳ Symptom Association Explanation</li><li>↳ Symptom</li><li>↳ Association</li><li>↳ Explanation</li><li>↳ Tingling at extremities Anxiety and somatic symptoms Common physical manifestation of anxiety or hyperventilation</li><li>↳ Tingling at extremities</li><li>↳ Anxiety and somatic symptoms</li><li>↳ Common physical manifestation of anxiety or hyperventilation</li><li>↳ Neologisms Psychotic disorders (schizophrenia) Not typical in anxiety or somatic symptom disorders</li><li>↳ Neologisms</li><li>↳ Psychotic disorders (schizophrenia)</li><li>↳ Not typical in anxiety or somatic symptom disorders</li><li>↳ Hallucinations Psychotic disorders Not present in anxiety disorders</li><li>↳ Hallucinations</li><li>↳ Psychotic disorders</li><li>↳ Not present in anxiety disorders</li><li>↳ Idea of reference Delusional symptom in schizophrenia Not consistent with anxiety or somatic complaints</li><li>↳ Idea of reference</li><li>↳ Delusional symptom in schizophrenia</li><li>↳ Not consistent with anxiety or somatic complaints</li><li>↳ Neologisms (Option A): Incorrect because neologisms are made-up words seen in schizophrenia, not anxiety disorders.</li><li>↳ Hallucinations (Option C): Incorrect because hallucinations are not features of anxiety disorders.</li><li>↳ Idea of reference (Option D): Incorrect because this is a psychotic symptom not typical in anxiety or somatic symptom disorders.</li></ul>\n<table>\n<thead>\n<tr>\n<th>Symptom</th>\n<th>Association</th>\n<th>Explanation</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>Tingling at extremities</td>\n<td>Anxiety and <span class=\"customMeta\" data-dictid=\"3db910d8571692777198303e3bcb27\">somatic</span> symptoms</td>\n<td>Common physical manifestation of anxiety or hyperventilation</td>\n</tr>\n<tr>\n<td>Neologisms</td>\n<td>Psychotic disorders (schizophrenia)</td>\n<td>Not typical in anxiety or <span class=\"customMeta\" data-dictid=\"3db910d8571692777198303e3bcb27\">somatic</span> symptom disorders</td>\n</tr>\n<tr>\n<td>Hallucinations</td>\n<td>Psychotic disorders</td>\n<td>Not present in anxiety disorders</td>\n</tr>\n<tr>\n<td>Idea of reference</td>\n<td>Delusional symptom in schizophrenia</td>\n<td>Not consistent with anxiety or <span class=\"customMeta\" data-dictid=\"3db910d8571692777198303e3bcb27\">somatic</span> complaints</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which phases of the disaster cycle can be included in the recovery phase (multiple choice)? Response Rehabilitation Mitigation Preparedness", "options": [{"label": "A", "text": "1 and 2", "correct": true}, {"label": "B", "text": "1 and 3", "correct": false}, {"label": "C", "text": "2 and 3", "correct": false}, {"label": "D", "text": "3 and 4", "correct": false}], "correct_answer": "A. 1 and 2", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Gl8KwxeT8BbMQiQ9TVc61747851932.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old female patient complains of a persistent headache. A CT scan of the head was performed, as shown below. What is the most accurate diagnosis?", "options": [{"label": "A", "text": "Subarachnoid hemorrhage (SAH)", "correct": true}, {"label": "B", "text": "Epidural hemorrhage", "correct": false}, {"label": "C", "text": "Subdural hemorrhage", "correct": false}, {"label": "D", "text": "Intraparenchymal hemorrhage", "correct": false}], "correct_answer": "A. Subarachnoid hemorrhage (SAH)", "question_images": ["https://image.prepladder.com/content/iXtKu4t7KHCLol37hVxF1724748704.png"], "explanation_images": ["https://image.prepladder.com/content/5mE1NLWt2zAwtK378Skw1724842856.png", "https://image.prepladder.com/content/3WNH5T4nGBaqEnbUgUNh1724842873.png", "https://image.prepladder.com/content/cqrUaGYNj1z9jttUlF2y1724842885.png", "https://image.prepladder.com/content/oZFAQghgjbVRFKTr6G7S1724842930.png"], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"0a5d82eeef169277719934b86fb07b\"&gt;Subarachnoid&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"4642acfc0c16927771880b34fa5174\"&gt;hemorrhage&lt;/span&gt; (SAH)\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Impaired gag reflex is caused by a lesion in which of the following cranial nerves?", "options": [{"label": "A", "text": "CN V and VI", "correct": false}, {"label": "B", "text": "CN X and XI", "correct": false}, {"label": "C", "text": "CN IX and X", "correct": true}, {"label": "D", "text": "CN VII and VIII", "correct": false}], "correct_answer": "C. CN IX and X", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - CN IX and X\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Oropharynx, <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> 1/3<sup>rd</sup> of tongue, tonsils, <span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\">posterior</span> pharyngeal wall</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Glossopharyngeal nerve</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Larynx and hypopharynx, <span class=\"customMeta\" data-dictid=\"25c6ce766c1692777184ab9a40305c\">cervical</span> oesophagus</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Vagus nerve</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is true regarding the image provided?", "options": [{"label": "A", "text": "EMLA contains ropivacaine and ligocaine", "correct": false}, {"label": "B", "text": "EMLA can lead to methemoglobinemia", "correct": true}, {"label": "C", "text": "EMLA contains 5% lignocaine", "correct": false}, {"label": "D", "text": "EMLA acts within 15 mins", "correct": false}], "correct_answer": "B. EMLA can lead to methemoglobinemia", "question_images": ["https://image.prepladder.com/content/NZQ8HCzFpXJVeasZWJi91724762448.png"], "explanation_images": ["https://image.prepladder.com/content/ZtI0btNjFdujWxGWnK0a1724821800.png"], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"4d27d7c9dc1692777187dfb504dcf2\"&gt;EMLA&lt;/span&gt; can lead to methemog\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A heavy lifter presents with lower back ache. Identify the nerve compressed in the following disc prolapse?", "options": [{"label": "A", "text": "L4", "correct": false}, {"label": "B", "text": "L5", "correct": true}, {"label": "C", "text": "S1", "correct": false}, {"label": "D", "text": "S4", "correct": false}], "correct_answer": "B. L5", "question_images": ["https://image.prepladder.com/content/7lZvqLbZCjFrq0K3BROD1724837896.png"], "explanation_images": [], "explanation": "<p>Correct Option B - L5\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is a selective norepinephrine reuptake inhibitor used in the management of ADHD?", "options": [{"label": "A", "text": "Modafinil", "correct": false}, {"label": "B", "text": "Reboxetine", "correct": true}, {"label": "C", "text": "Guanfacine", "correct": false}, {"label": "D", "text": "Methylphenidate", "correct": false}], "correct_answer": "B. Reboxetine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B – R\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 23-year-old female with a height of 4 feet has a karyotype, as shown in the image below. Which of the following conditions is the most likely etiology?", "options": [{"label": "A", "text": "Turner syndrome", "correct": true}, {"label": "B", "text": "Klinefelter syndrome", "correct": false}, {"label": "C", "text": "Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS)", "correct": false}, {"label": "D", "text": "Edwards syndrome", "correct": false}], "correct_answer": "A. Turner syndrome", "question_images": ["https://image.prepladder.com/content/VTnBQJ9cT9tgHcDyRA2e1724915032.png"], "explanation_images": ["https://image.prepladder.com/content/8K5A7u6typtOZl8D3Bk51724850005.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ZzdlKdS5T6BFwBoW91GS1748420694.mp3", "video": ""}, {"text": "A patient with prolonged intubation complained of respiratory distress. Which of the following staging systems is used to stage the condition shown in the image?", "options": [{"label": "A", "text": "Cottom-Meyer classification", "correct": true}, {"label": "B", "text": "Radkowski classification", "correct": false}, {"label": "C", "text": "TNM classification", "correct": false}, {"label": "D", "text": "AJCC classification", "correct": false}], "correct_answer": "A. Cottom-Meyer classification", "question_images": ["https://image.prepladder.com/content/U5KgjNdbYs0bM5XGHCW41724839619.png"], "explanation_images": ["https://image.prepladder.com/content/i12AlUKikqFc1jZkcRvQ1724909139.png"], "explanation": "<p>Correct Option A - Cotton-M\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Calculate the median of the following data set: 2, 3, 4, 4, 5, 6, 7, 8.", "options": [{"label": "A", "text": "4", "correct": false}, {"label": "B", "text": "4.5", "correct": true}, {"label": "C", "text": "4.8", "correct": false}, {"label": "D", "text": "5", "correct": false}], "correct_answer": "B. 4.5", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/2W7yZYlKnRT1ciLQNcne1724842129.png", "https://image.prepladder.com/content/V71mLRjeYFEsVh620rEX1724842160.png"], "explanation": "<p>Correct Option B - 4.5\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In medicolegal examination accused 18 year old male claims he is 16 year old. Which joint x-ray should be done?", "options": [{"label": "A", "text": "Head &amp;amp; shoulder", "correct": false}, {"label": "B", "text": "Elbow and ankle", "correct": false}, {"label": "C", "text": "Knee and wrist", "correct": true}, {"label": "D", "text": "Elbow &amp;amp; hip", "correct": false}], "correct_answer": "C. Knee and wrist", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - K\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the arrow marked nerve:", "options": [{"label": "A", "text": "Medial pectoral nerve", "correct": true}, {"label": "B", "text": "Lateral pectoral nerve", "correct": false}, {"label": "C", "text": "Long thoracic nerve", "correct": false}, {"label": "D", "text": "Thoracodorsal nerve", "correct": false}], "correct_answer": "A. Medial pectoral nerve", "question_images": ["https://image.prepladder.com/content/1VNXqBHG5TqVFLORUcpB1724927859.png"], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"db46007ad21692777192dcc160a2e2\"&gt;Medial&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"f991d64bc81692777195b12eec7a84\"&gt;pectoral&lt;/span&gt; nerv\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following drugs is appropriate for treating a 75-year-old woman with urinary incontinence triggered by stress, such as coughing?", "options": [{"label": "A", "text": "Ipratropium", "correct": false}, {"label": "B", "text": "Tolterodine", "correct": true}, {"label": "C", "text": "Telenzepine", "correct": false}, {"label": "D", "text": "Tropicamide", "correct": false}], "correct_answer": "B. Tolterodine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - T\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td><strong>Drug</strong></td>\n<td><strong>Mechanism of Action</strong></td>\n</tr>\n<tr>\n<td><strong>Tolterodine</strong></td>\n<td>Selective <span class=\"customMeta\" data-dictid=\"0ad3c97c2916927771938768dcf298\">muscarinic</span> <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antagonist</td>\n</tr>\n<tr>\n<td><strong>Oxybutynin</strong></td>\n<td>Muscarinic <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antagonist</td>\n</tr>\n<tr>\n<td><strong>Solifenacin</strong></td>\n<td>M3 selective <span class=\"customMeta\" data-dictid=\"0ad3c97c2916927771938768dcf298\">muscarinic</span> <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antagonist</td>\n</tr>\n<tr>\n<td><strong>Darifenacin</strong></td>\n<td>M3 selective <span class=\"customMeta\" data-dictid=\"0ad3c97c2916927771938768dcf298\">muscarinic</span> <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antagonist</td>\n</tr>\n<tr>\n<td><strong>Fesoterodine</strong></td>\n<td>Prodrug of tolterodine, <span class=\"customMeta\" data-dictid=\"0ad3c97c2916927771938768dcf298\">muscarinic</span> antagonist</td>\n</tr>\n<tr>\n<td><strong>Trospium</strong></td>\n<td>Muscarinic <span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\">receptor</span> antagonist</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with perianal itching. A perianal swab was taken, and the image below shows the findings. What is the most likely diagnosis?", "options": [{"label": "A", "text": "H Nana", "correct": false}, {"label": "B", "text": "Ancylostoma", "correct": false}, {"label": "C", "text": "Enterobius vermicularis", "correct": true}, {"label": "D", "text": "Necator Americanus", "correct": false}], "correct_answer": "C. Enterobius vermicularis", "question_images": ["https://image.prepladder.com/content/1jwZZQN7a2uhJhnyw1U51724836957.png"], "explanation_images": [], "explanation": "<p>Correct Option C - Enterobius vermicu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 62-year-old patient presents with left-sided arm and leg weakness, right-sided facial paralysis, and difficulty with horizontal eye movements. Based on the clinical presentation, which of the following syndromes is most consistent with these symptoms?", "options": [{"label": "A", "text": "Foville syndrome", "correct": false}, {"label": "B", "text": "Benedict's syndrome", "correct": false}, {"label": "C", "text": "Millard-Gubler syndrome", "correct": true}, {"label": "D", "text": "Wallenberg syndrome", "correct": false}], "correct_answer": "C. Millard-Gubler syndrome", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Millard-Gu\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\">\n<p>Millard-Gubler syndrome</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\">\n<p><strong>Key Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\">\n<p>Contralateral <span class=\"customMeta\" data-dictid=\"4e69f1c7691692777188a80c8ffd0d\">hemiplegia</span> (due to <span class=\"customMeta\" data-dictid=\"a218fdbabf1692777185a2d48a9e1c\">corticospinal</span> <span class=\"customMeta\" data-dictid=\"1a1307223f16927772017a994bfc39\">tract</span> involvement), <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> CN VI and VII <span class=\"customMeta\" data-dictid=\"f3e67cebd51692777194f5257898e4\">palsy</span> (resulting in <span class=\"customMeta\" data-dictid=\"9fdd7489051692777202cffe3f24cc\">facial</span> <span class=\"customMeta\" data-dictid=\"72fa9105b916927771945aef35e8ed\">paralysis</span> and gaze palsy)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\">\n<p><strong>Anatomical Location</strong></p>\n</td>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\">\n<p>Lesion in the <span class=\"customMeta\" data-dictid=\"9ccb2fd2f31692777201e231bfda74\">ventral</span> pons</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\">\n<p><strong>Differential Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\">\n<p>Distinguished from other <span class=\"customMeta\" data-dictid=\"4004f1f7241692777183d200f866da\">brainstem</span> syndromes like Foville (involves more extensive gaze palsy), Benedict’s (midbrain involvement), and Wallenberg (lateral <span class=\"customMeta\" data-dictid=\"0a36e18386169277719259641cf29b\">medullary</span> syndrome)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\">\n<p><strong>Rationale</strong></p>\n</td>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\">\n<p>The clinical features of <span class=\"customMeta\" data-dictid=\"1a5d9f72801692777185eb596f3d64\">contralateral</span> <span class=\"customMeta\" data-dictid=\"4e69f1c7691692777188a80c8ffd0d\">hemiplegia</span> with <span class=\"customMeta\" data-dictid=\"ca762506461692777190f12b43bb1a\">ipsilateral</span> CN VI and VII <span class=\"customMeta\" data-dictid=\"f3e67cebd51692777194f5257898e4\">palsy</span> are classic for Millard-Gubler syndrome due to a <span class=\"customMeta\" data-dictid=\"9ccb2fd2f31692777201e231bfda74\">ventral</span> <span class=\"customMeta\" data-dictid=\"a533b2d59f1692777196694dbb1b2a\">pontine</span> lesion.</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The formula with the numerator being maternal deaths and the denominator being women of reproductive age represents which of the following?", "options": [{"label": "A", "text": "Maternal mortality rate", "correct": true}, {"label": "B", "text": "Maternal mortality ratio", "correct": false}, {"label": "C", "text": "Perinatal mortality rate", "correct": false}, {"label": "D", "text": "Perinatal mortality ratio", "correct": false}], "correct_answer": "A. Maternal mortality rate", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/0rrW2d8111SYrsgbQpk91724850120.png"], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"a191a950d7169277719148e72a75e2\"&gt;Maternal&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient of CKD has tachycardia. An ECG is taken and shown below. What’s the most likely diagnosis?", "options": [{"label": "A", "text": "Hyperkalemia", "correct": true}, {"label": "B", "text": "Hypokalemia", "correct": false}, {"label": "C", "text": "Hypercalcemia", "correct": false}, {"label": "D", "text": "Hypocalcemia", "correct": false}], "correct_answer": "A. Hyperkalemia", "question_images": ["https://image.prepladder.com/content/eL0QSDC8wkl0Ah63oBIa1724847289.png"], "explanation_images": [], "explanation": "<p>Correct Option A - Hyperk\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A pregnant female at 37 weeks of gestation presents for a routine antenatal checkup. She is currently on warfarin. What would be the next step?", "options": [{"label": "A", "text": "Switch to LMWH", "correct": true}, {"label": "B", "text": "Immediate induction", "correct": false}, {"label": "C", "text": "LSCS (Lower Segment Caesarean Section)", "correct": false}, {"label": "D", "text": "Continue the same", "correct": false}], "correct_answer": "A. Switch to LMWH", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Switch to LMWH\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Police brought a person from the railway track with features of dry dilated pupil, dry skin , slurring of speech , altered sensorium. The poisoning is?", "options": [{"label": "A", "text": "Morphine", "correct": false}, {"label": "B", "text": "Cannabis", "correct": false}, {"label": "C", "text": "Datura", "correct": true}, {"label": "D", "text": "Alcohol", "correct": false}], "correct_answer": "C. Datura", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Datu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Behind the medial malleolus and in front of Achilles which artery is present?", "options": [{"label": "A", "text": "Posterior tibial artery", "correct": true}, {"label": "B", "text": "Peroneal artery", "correct": false}, {"label": "C", "text": "Anterior tibial artery", "correct": false}, {"label": "D", "text": "Dorsalis pedis artery", "correct": false}], "correct_answer": "A. Posterior tibial artery", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\"&gt;Posterior&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"f2a519f38316927772004fe7c606af\"&gt;tibial&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with multiple tendon xanthomas is found to have a serum cholesterol level of 398 mg/dL and an LDL level of 220 mg/dL. What is the most likely defect?", "options": [{"label": "A", "text": "Lipoprotein lipase deficiency", "correct": false}, {"label": "B", "text": "LDL receptor defect", "correct": true}, {"label": "C", "text": "Defective Apo B-100", "correct": false}, {"label": "D", "text": "PCSK9 gain-of-function mutation", "correct": false}], "correct_answer": "B. LDL receptor defect", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - LDL &lt;span class=\"customMeta\" data-dictid=\"9e4959f6f316927771978bb152d440\"&gt;receptor&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child was born after 8 months of father's death. Grandparents filed a case that the baby is not their son's. DNA is positive. The child is called ?", "options": [{"label": "A", "text": "Suppositious child", "correct": false}, {"label": "B", "text": "Fabricated child", "correct": false}, {"label": "C", "text": "Posthumous child", "correct": true}, {"label": "D", "text": "Illegitimate child", "correct": false}], "correct_answer": "C. Posthumous child", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"e8909b94a516927771964b51239053\"&gt;Posthumous&lt;/span&gt; ch\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 2-month-old child is brought to the ophthalmology OPD with the following presentation. What is the ideal management?", "options": [{"label": "A", "text": "Medical management", "correct": false}, {"label": "B", "text": "Operate immediately", "correct": true}, {"label": "C", "text": "Surgery after 6 months", "correct": false}, {"label": "D", "text": "Surgery after 2 years", "correct": false}], "correct_answer": "B. Operate immediately", "question_images": ["https://image.prepladder.com/content/otp6QfQe1sIMWsNbK88p1724833060.png"], "explanation_images": [], "explanation": "<p>Correct Option B - O\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "An 8-year-old male child presents with fever and tenderness in the left lower limb. The limb is warm to the touch, and ESR is raised. An X-ray reveals periosteal elevation. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Ewing sarcoma", "correct": false}, {"label": "B", "text": "Osteosarcoma", "correct": false}, {"label": "C", "text": "Osteomyelitis", "correct": true}, {"label": "D", "text": "Giant Cell Tumor (GCT)", "correct": false}], "correct_answer": "C. Osteomyelitis", "question_images": ["https://image.prepladder.com/content/phuM81OlpPGkmisL3pEH1748205848.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the stage of disease given in the image.", "options": [{"label": "A", "text": "Type 1", "correct": false}, {"label": "B", "text": "Type 2", "correct": true}, {"label": "C", "text": "Type 3", "correct": false}, {"label": "D", "text": "Type 4", "correct": false}], "correct_answer": "B. Type 2", "question_images": ["https://image.prepladder.com/content/Yumudfhr1BNCdACqVjtJ1724928271.png"], "explanation_images": ["https://image.prepladder.com/content/Kn4vLBH4VhjHuLki2bkc1724850292.png"], "explanation": "<p>Correct Option B - Type 2:</p>\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>WHO-IWGE staging</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Gharbi classification</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Description</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Stage</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>CE1</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Type I</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Unilocular <span class=\"customMeta\" data-dictid=\"acb59b05f31692777181d2df5f618b\">anechoic</span> <span class=\"customMeta\" data-dictid=\"38c41e122116927771859b63deb0ed\">cystic</span> <span class=\"customMeta\" data-dictid=\"d5e7bb15851692777191b39417c26a\">lesion</span> with double line sign</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Active</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>CE2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Type III</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Multiseptated, \"rosette-like\" \"honeycomb\" cyst</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Active</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>CE3 A</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Type II</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cyst with detached membranes (water-lily sign)</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Transitional</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>CE3 B</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Type III</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cyst with daughter cysts in solid matrix</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Transitional</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>CE4</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Type IV</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Cyst with <span class=\"customMeta\" data-dictid=\"b2dafdf91e16927771884f1d4b5107\">heterogenous</span> hypoechoic/hyperechoic contents. No daughter cysts</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inactive</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>CE5</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Type V</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Solid <span class=\"customMeta\" data-dictid=\"1405ad7b46169277718580acad7562\">cyst</span> with calcified wall</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Inactive</p>\n</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the inclusion criterion for starting bedaquiline in a patient presenting with multidrug-resistant (MDR) or rifampicin-resistant (RR) tuberculosis?", "options": [{"label": "A", "text": "Resistance to both rifampicin and isoniazid with mutations in the inhA and katG genes", "correct": true}, {"label": "B", "text": "Resistance to rifampicin but sensitivity to fluoroquinolones", "correct": false}, {"label": "C", "text": "Resistance to rifampicin and sensitivity to isoniazid", "correct": false}, {"label": "D", "text": "Resistance to both rifampicin and fluoroquinolones", "correct": false}], "correct_answer": "A. Resistance to both rifampicin and isoniazid with mutations in the inhA and katG genes", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Resistance to Both &lt;span class=\"customMeta\" data-dictid=\"6cd890fc7416927771978562618db8\"&gt;Rifampicin&lt;/span&gt; and &lt;span class=\"customMeta\" data-dictid=\"5d8c24b3cb16927771909a5195d7f8\"&gt;Isoniazid&lt;/span&gt; with Mutations in the inhA and katG G\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 14-year-old child with a history of recurrent bleeding undergoes an endoscopic examination, which is given below. What is the investigation of choice (IOC) for this condition?", "options": [{"label": "A", "text": "Contrast-Enhanced CT (CECT)", "correct": true}, {"label": "B", "text": "Biopsy", "correct": false}, {"label": "C", "text": "X-ray", "correct": false}, {"label": "D", "text": "MRI", "correct": false}], "correct_answer": "A. Contrast-Enhanced CT (CECT)", "question_images": ["https://image.prepladder.com/content/FHthykvOn3sR9I0y3RRE1724840326.png"], "explanation_images": ["https://image.prepladder.com/content/ePUtKu77EjRQmdyieTav1724840341.png", "https://image.prepladder.com/content/EaIZOkDElsjJIs5jfaVV1724840369.png"], "explanation": "<p>Correct Option A - Contrast-Enhanced CT (CECT)\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Endoscopic image show following finding what is the diagnosis?", "options": [{"label": "A", "text": "Barretts esophagus", "correct": false}, {"label": "B", "text": "Esophageal varices", "correct": true}, {"label": "C", "text": "Gastric erosion", "correct": false}, {"label": "D", "text": "Chronic GERD", "correct": false}], "correct_answer": "B. Esophageal varices", "question_images": ["https://image.prepladder.com/content/jikAIsqPH97EvQeNva7R1724928472.png"], "explanation_images": ["https://image.prepladder.com/content/N9aIF2xG1Lz8SiibXcNI1724928536.png"], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"192677035a169277718780b4d6dbbb\"&gt;Esophageal&lt;/span&gt; v\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Chelator contraindicated in Iron poisoning?", "options": [{"label": "A", "text": "Calcium disodium EDTA", "correct": false}, {"label": "B", "text": "Deferoxamine", "correct": false}, {"label": "C", "text": "British anti lewsite (BAL)", "correct": true}, {"label": "D", "text": "Penicillamine", "correct": false}], "correct_answer": "C. British anti lewsite (BAL)", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - British Anti-Lewisite (BAL)\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the likely diagnosis for a G2P1L1 woman with a history of hysterectomy?", "options": [{"label": "A", "text": "Placenta accreta", "correct": true}, {"label": "B", "text": "Placenta inversion", "correct": false}, {"label": "C", "text": "Placenta abruption", "correct": false}, {"label": "D", "text": "Placenta previa", "correct": false}], "correct_answer": "A. Placenta accreta", "question_images": ["https://image.prepladder.com/content/9kkG9cLOWY4vM5XSlO3C1724757713.png"], "explanation_images": ["https://image.prepladder.com/content/5QsiXK1v1GloN5z2EUds1724827855.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Patient present with large sweaty hands, macroglossia and frontal bossing. Select the best test for confirmation of the diagnosis:", "options": [{"label": "A", "text": "GHRH levels", "correct": false}, {"label": "B", "text": "IGF- 1", "correct": false}, {"label": "C", "text": "IGF- 2", "correct": false}, {"label": "D", "text": "GH levels after glucose suppression", "correct": true}], "correct_answer": "D. GH levels after glucose suppression", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - GH levels after &lt;span class=\"customMeta\" data-dictid=\"af3ae60c0c16927771889b84ca41c0\"&gt;glucose&lt;/span&gt; su\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with a gradual loss of night vision and peripheral vision. What is the most likely diagnosis based on fundoscopy findings?", "options": [{"label": "A", "text": "Retinitis pigmentosa", "correct": true}, {"label": "B", "text": "Retinal hemorrhage", "correct": false}, {"label": "C", "text": "Diabetic retinopathy", "correct": false}, {"label": "D", "text": "Hypertensive retinopathy", "correct": false}], "correct_answer": "A. Retinitis pigmentosa", "question_images": ["https://image.prepladder.com/content/V9PfiPNqv9zUd321UY531724828556.png"], "explanation_images": ["https://image.prepladder.com/content/36gjTNFf0UKaq195QXpu1724828697.png"], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"4f1a033cae1692777197a3a6937a0c\"&gt;Retinitis&lt;/span&gt; pig\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which disease is commonly referred to as \"Desert Rheumatism\"?", "options": [{"label": "A", "text": "Coccidomycosis", "correct": true}, {"label": "B", "text": "Histoplasmosis", "correct": false}, {"label": "C", "text": "Paracoccidioidomycosis", "correct": false}, {"label": "D", "text": "Mucormycosis", "correct": false}], "correct_answer": "A. Coccidomycosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - C\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which classification is used for the following fracture, and what is its stage?", "options": [{"label": "A", "text": "Gartland 3", "correct": true}, {"label": "B", "text": "Gartland 2", "correct": false}, {"label": "C", "text": "Salter harris 3", "correct": false}, {"label": "D", "text": "Salter harris 2", "correct": false}], "correct_answer": "A. Gartland 3", "question_images": ["https://image.prepladder.com/content/9j4dZSPEZIHLwgcnqdb81724755617.png"], "explanation_images": ["https://image.prepladder.com/content/tVf6CF0McVo3DEJX7jgD1724837186.png", "https://image.prepladder.com/content/UU7UgJVDoAKRHp93IQOE1724837214.png"], "explanation": "<p>Correct Option A - Gartland 3\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the correct order of disaster management steps?", "options": [{"label": "A", "text": "Impact-Response- Rehab-Mitigation", "correct": true}, {"label": "B", "text": "Response- Rehab- Mitigation- Impact", "correct": false}, {"label": "C", "text": "Rehab- mItigation-Response-Impact", "correct": false}, {"label": "D", "text": "Mitigation-Response-Impact-Rehab", "correct": false}], "correct_answer": "A. Impact-Response- Rehab-Mitigation", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/qePL1eo51JVAr5XkJ60N1724851217.png"], "explanation": "<p>Correct Option A: Impact - Response - Rehab - Mitig\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which muscle is implicated in ptosis in Horner syndrome?", "options": [{"label": "A", "text": "Müller muscle", "correct": true}, {"label": "B", "text": "Levator aponeurosis", "correct": false}, {"label": "C", "text": "Horner muscle", "correct": false}, {"label": "D", "text": "Orbicularis oculi", "correct": false}], "correct_answer": "A. Müller muscle", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Müller mu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with a history of Wilson's disease presents with neurological manifestations. Which of the following is the best diagnostic modality?", "options": [{"label": "A", "text": "Serum ceruloplasmin", "correct": false}, {"label": "B", "text": "Urinary copper excretion", "correct": false}, {"label": "C", "text": "Hepatic parenchymal demonstration of copper", "correct": true}, {"label": "D", "text": "Anti-tissue transglutaminase (Anti-tTG) antibody", "correct": false}], "correct_answer": "C. Hepatic parenchymal demonstration of copper", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"3268e86ce01692777188f249c64d6e\"&gt;Hepatic&lt;/span&gt; parench\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Wilson's Disease</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Key <span class=\"customMeta\" data-dictid=\"552e9ef8811692777186997018b858\">Diagnostic</span> Modality</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hepatic parenchymal demonstration of copper</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Associated Tests</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Serum <span class=\"customMeta\" data-dictid=\"d0297935661692777184085cf7e86f\">ceruloplasmin</span> (low), <span class=\"customMeta\" data-dictid=\"0b72f5e96b16927772018dec8a87e2\">urinary</span> <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> <span class=\"customMeta\" data-dictid=\"0f7653c9ef1692777187deaa35f749\">excretion</span> (high), Kayser-Fleischer rings (ophthalmic exam)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Rationale for Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Hepatic <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> concentration is the gold standard for diagnosis, especially in patients with neurological symptoms.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Differential Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Differentiated from other causes of liver disease and neurological disorders by the combination of clinical, biochemical, and <span class=\"customMeta\" data-dictid=\"1e9c8202241692777189dbac6cc062\">histological</span> findings.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Treatment Implications</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Early diagnosis is crucial for the <span class=\"customMeta\" data-dictid=\"a4f93a26c11692777190f1659fa7c9\">initiation</span> of <span class=\"customMeta\" data-dictid=\"11199cbd1816927771841f1eb35b86\">chelation</span> therapy to prevent further <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> accumulation and damage.</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Based on the provided chest X-ray, which of the following procedures would be most challenging to perform?", "options": [{"label": "A", "text": "Tracheostomy", "correct": true}, {"label": "B", "text": "Laryngeal Mask Airway (LMA) insertion", "correct": false}, {"label": "C", "text": "Ryle’s Tube (RT) insertion", "correct": false}, {"label": "D", "text": "Indirect laryngoscopy", "correct": false}], "correct_answer": "A. Tracheostomy", "question_images": ["https://image.prepladder.com/content/T1xlpx4viTNM6o8Hmj0B1724839949.png"], "explanation_images": ["https://image.prepladder.com/content/nH5qK6vhZ0QFeqc2iKdh1724839974.png"], "explanation": "<p>Correct Option A - Trach\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with an umbilical hernia that was previously reducible but has now become irreducible. Which of the following is the most appropriate management option?", "options": [{"label": "A", "text": "Umblical excision", "correct": true}, {"label": "B", "text": "Umbilical excision with mesh hernioplasty", "correct": false}, {"label": "C", "text": "Mesh hernioplasty", "correct": false}, {"label": "D", "text": "Conservative management", "correct": false}], "correct_answer": "A. Umblical excision", "question_images": ["https://image.prepladder.com/content/qM3ALp7vsaWCa29pFM8H1724928697.png"], "explanation_images": ["https://image.prepladder.com/content/i0JA88oaopuLKvkDlxU31724929277.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A woman diagnosed with impending eclampsia is started on the Pritchard regimen for magnesium sulfate administration. Under which of the following conditions should the treatment be stopped?", "options": [{"label": "A", "text": "Respiratory rate (RR) &amp;lt; 18 breaths per minute", "correct": false}, {"label": "B", "text": "Visual disturbances start", "correct": false}, {"label": "C", "text": "Knee jerk reflex is present", "correct": false}, {"label": "D", "text": "Urine output less than 60 ml in 4 hours", "correct": true}], "correct_answer": "D. Urine output less than 60 ml in 4 hours", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following signs can be appreciated in the given X-ray?", "options": [{"label": "A", "text": "Steeple sign", "correct": false}, {"label": "B", "text": "String sign", "correct": false}, {"label": "C", "text": "Thumb sign", "correct": false}, {"label": "D", "text": "Double ring sign", "correct": true}], "correct_answer": "D. Double ring sign", "question_images": ["https://image.prepladder.com/content/CEgwGV6jTGGnffE2XjeK1724840155.png"], "explanation_images": ["https://image.prepladder.com/content/ZwfgRKOStu0la8s8C2fH1724840251.png", "https://image.prepladder.com/content/LnayeAZoJ6lOCGTMXGz91724840188.png", "https://image.prepladder.com/content/xbwlva2MYZiDXi4IocrJ1724840221.png"], "explanation": "<p>Correct Option D - Double ring sig\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female presents to the OPD with complaints of dysuria. Based on the microscopic examination, what is the most likely diagnosis?", "options": [{"label": "A", "text": "HSV", "correct": true}, {"label": "B", "text": "CMV", "correct": false}, {"label": "C", "text": "HPV", "correct": false}, {"label": "D", "text": "Trichomonas", "correct": false}], "correct_answer": "A. HSV", "question_images": ["https://image.prepladder.com/content/YfiQb9Ri7WRxaAhOduql1724914985.png"], "explanation_images": [], "explanation": "<p>Correct Option A – HSV\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old female presents with an irregular 5 x 6 cm mass in the right breast. Histopathological examination reveals findings consistent with which of the following diagnoses?", "options": [{"label": "A", "text": "Phylloid tumor", "correct": true}, {"label": "B", "text": "Fibroadenoma", "correct": false}, {"label": "C", "text": "Mastitis", "correct": false}, {"label": "D", "text": "Grade 2 breast tumor", "correct": false}], "correct_answer": "A. Phylloid tumor", "question_images": ["https://image.prepladder.com/content/BdxjqgKtJAQxOqdEPF171724910270.png"], "explanation_images": ["https://image.prepladder.com/content/05OBrUo1PNUnoViyVgOv1724851533.png"], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"5ea5a8a7d71692777195dd957c9057\"&gt;Phyllodes&lt;/span&gt; tu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The dead body shows the following finding as in image . What is this case?", "options": [{"label": "A", "text": "Hanging", "correct": false}, {"label": "B", "text": "Throttling", "correct": false}, {"label": "C", "text": "Choking", "correct": false}, {"label": "D", "text": "Smothering", "correct": true}], "correct_answer": "D. Smothering", "question_images": ["https://image.prepladder.com/content/kjwn7sRajeCPBLfXy8451724820672.png"], "explanation_images": [], "explanation": "<p>Correct Option D - Smothering\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:215px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\">\n<p><strong>Correct Answer</strong></p>\n</td>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\">\n<p>Smothering</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\"><strong>Characteristics</strong></td>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\">Bruises around the <span class=\"customMeta\" data-dictid=\"c3d268847f1692777195cc94cc643f\">perioral</span> region, nail abrasions around lips and nose, petechial hemorrhages.</td>\n</tr>\n<tr>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\"><strong>Reason</strong></td>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\">Smothering obstructs the airways with an external object, causing characteristic external injuries.</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:617px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\">\n<p> </p>\n</td>\n</tr>\n</tbody>\n</table>\n<table cellspacing=\"0\" style=\"border-collapse:collapse; width:617px\">\n<tbody>\n<tr>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\">\n<p><strong>Reason</strong></p>\n</td>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\">\n<p>Smothering obstructs the airways with an external object, causing characteristic external injuries.</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "During the Worth 4 Dot Test, a patient sees only three green dots. What is the likely diagnosis?", "options": [{"label": "A", "text": "Right eye suppression", "correct": true}, {"label": "B", "text": "Left eye suppression", "correct": false}, {"label": "C", "text": "Crossed diplopia with esodeviation", "correct": false}, {"label": "D", "text": "Crossed diplopia with exodeviation", "correct": false}], "correct_answer": "A. Right eye suppression", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Y3saRH5LSqzDuYL1cl0J1724830517.png"], "explanation": "<p>Correct Option A - Right eye su\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with headaches, palpitations, and hypertension. On laboratory examination, urine VMA is positive. His biopsy findings are given below. Which of the following is a correct statement?", "options": [{"label": "A", "text": "Mostly malignant", "correct": false}, {"label": "B", "text": "Mostly in children", "correct": false}, {"label": "C", "text": "Mostly bilateral", "correct": false}, {"label": "D", "text": "Associated with MEN2A", "correct": true}], "correct_answer": "D. Associated with MEN2A", "question_images": ["https://image.prepladder.com/content/7HAe7cyzygGAEYUUFyBi1724852454.png"], "explanation_images": [], "explanation": "<p>Correct Option D - Associated with MEN2A\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old patient presents with a history of flat lesions near the anal canal, rashes on the body, and hair loss that follows a particular pattern, as shown in the image. What is the diagnosis?", "options": [{"label": "A", "text": "Trichotillomania", "correct": false}, {"label": "B", "text": "Alopecia areata", "correct": false}, {"label": "C", "text": "Secondary syphilis", "correct": true}, {"label": "D", "text": "Malassezia", "correct": false}], "correct_answer": "C. Secondary syphilis", "question_images": ["https://image.prepladder.com/content/5j5sQRESeV7TqC4LcUYE1724752156.png"], "explanation_images": [], "explanation": "<p>Correct Option C - Secondary syph\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the orthopedic implant shown in the image", "options": [{"label": "A", "text": "Dynamic hip screw", "correct": true}, {"label": "B", "text": "Adynamic hip screw", "correct": false}, {"label": "C", "text": "Condylar hip screw", "correct": false}, {"label": "D", "text": "Intramedullary nail", "correct": false}], "correct_answer": "A. Dynamic hip screw", "question_images": ["https://image.prepladder.com/content/f2eg90q8b3EjHHk4qxLP1724756230.png"], "explanation_images": ["https://image.prepladder.com/content/CXzEtbPdFoQ2iCqrXXW71748207656.png", "https://image.prepladder.com/content/PfZadOgL6SNLGHOtv7tw1748207687.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements about Von Willebrand's disease is incorrect?", "options": [{"label": "A", "text": "Type 2 von Willebrand disease is associated with a moderate bleeding tendency.", "correct": false}, {"label": "B", "text": "Type 3 von Willebrand disease is associated with a complete absence of von Willebrand factor.", "correct": false}, {"label": "C", "text": "Type 1 von Willebrand disease presents with severe bleeding since childhood.", "correct": true}, {"label": "D", "text": "Type 2 von Willebrand disease includes subtypes with varying defects in the von Willebrand factor.", "correct": false}], "correct_answer": "C. Type 1 von Willebrand disease presents with severe bleeding since childhood.", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"ebcb7136251692777201ef4b5c5718\"&gt;Type 1&lt;/span&gt; von Willebrand disease presents with severe &lt;span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\"&gt;bleeding&lt;/span&gt; since childh\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td style=\"text-align:center\"><strong>VWD Type 1</strong></td>\n<td style=\"text-align:center\"><strong>VWD Type 2</strong></td>\n<td style=\"text-align:center\"><strong>VWD Type 3</strong></td>\n</tr>\n<tr>\n<td>\n<ul>\n<li>Most common </li>\n<li>Mild <span class=\"customMeta\" data-dictid=\"209b85faf71692777185767d43e3bd\">deficiency</span> in VWF </li>\n<li>Quantitative defect </li>\n<li>Autosomal dominant </li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Autosomal dominant </li>\n<li>Qualitative defect </li>\n</ul>\n<p>Types</p>\n<ul>\n<li>2a - Decrease in binding between <span class=\"customMeta\" data-dictid=\"0327d20161169277720287847fa436\">VWF</span> and Gp1b/9.</li>\n<li>2b - Increase in binding between <span class=\"customMeta\" data-dictid=\"0327d20161169277720287847fa436\">VWF</span> and GP1b/9.</li>\n<li>2M</li>\n<li>2N</li>\n</ul>\n</td>\n<td>\n<ul>\n<li>Most severe</li>\n<li>Zero VWF</li>\n<li>Autosomal recessive </li>\n<li>Quantitative defect </li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with wheezing that improves with as-needed use of albuterol. Spirometry shows FEV1 ranging from 70% to 83%, and the patient experiences nighttime chest tightening twice a week. What is the most appropriate treatment?", "options": [{"label": "A", "text": "Continue with albuterol", "correct": false}, {"label": "B", "text": "Replace with salmeterol twice daily", "correct": false}, {"label": "C", "text": "Start Tab prednisolone", "correct": false}, {"label": "D", "text": "Add an inhaled corticosteroid", "correct": true}], "correct_answer": "D. Add an inhaled corticosteroid", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/ir1UrJ70nZ1LRFD0CA4B1724847345.png"], "explanation": "<p>Correct Option D - Add an inh\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is seen in the given image?", "options": [{"label": "A", "text": "Horner trantas spots", "correct": false}, {"label": "B", "text": "Herbert pits", "correct": true}, {"label": "C", "text": "Pannus", "correct": false}, {"label": "D", "text": "Corneal dystrophy", "correct": false}], "correct_answer": "B. Herbert pits", "question_images": ["https://image.prepladder.com/content/Dcs1IbvB8kQYWJ3Pf70X1724830816.png"], "explanation_images": ["https://image.prepladder.com/content/Tg7raRr37edSu1rco9p51724830828.png", "https://image.prepladder.com/content/8qFHp15NzlMbWM4L5rhw1724830896.png", "https://image.prepladder.com/content/8saaQjYxYivx223krD4P1724830941.png", "https://image.prepladder.com/content/QtKtHwDNvmh5DBuUJqL71724830974.png", "https://image.prepladder.com/content/t8X68ecPK4j0iWKg1EdQ1724831027.png"], "explanation": "<p>Correct Option B - H\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which ion is most responsible for the resting membrane potential (RMP)?", "options": [{"label": "A", "text": "Potassium (K + )", "correct": true}, {"label": "B", "text": "Calcium (Ca 2+ )", "correct": false}, {"label": "C", "text": "Sodium (Na + )", "correct": false}, {"label": "D", "text": "Chloride (Cl - )", "correct": false}], "correct_answer": "A. Potassium (K + )", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with the following laboratory values: pH 7.2, pCO2 13 mmHg, HCO3- 6 mEq/L, Na+ 136 mEq/L, Cl- 110 mEq/L. Which of the following is correct about this condition?", "options": [{"label": "A", "text": "Normal anion gap metabolic acidosis", "correct": false}, {"label": "B", "text": "High anion gap metabolic acidosis", "correct": true}, {"label": "C", "text": "Respiratory acidosis with metabolic alkalosis", "correct": false}, {"label": "D", "text": "Respiratory alkalosis with metabolic acidosis", "correct": false}], "correct_answer": "B. High anion gap metabolic acidosis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - High &lt;span class=\"customMeta\" data-dictid=\"53e82fca731692777181e629a02799\"&gt;anion&lt;/span&gt; gap &lt;span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\"&gt;metabolic&lt;/span&g\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Parameter</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Value</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Interpretation</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>pH</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>7.2</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Acidic, indicating acidosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>pCO2</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>13 mmHg</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low, indicating <span class=\"customMeta\" data-dictid=\"cfad80a0f716927771979aae100f95\">respiratory</span> compensation</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>HCO3-</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>6 mEq/L</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Very low, indicating <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> acidosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Anion Gap</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>20</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated, indicating high <span class=\"customMeta\" data-dictid=\"53e82fca731692777181e629a02799\">anion</span> gap <span class=\"customMeta\" data-dictid=\"d92cbff33316927771927b4de10a5b\">metabolic</span> acidosis</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the type of uterus shown in the image.", "options": [{"label": "A", "text": "Bicornuate", "correct": false}, {"label": "B", "text": "Didelphys", "correct": true}, {"label": "C", "text": "Arcuate", "correct": false}, {"label": "D", "text": "Aseptate", "correct": false}], "correct_answer": "B. Didelphys", "question_images": ["https://image.prepladder.com/content/z00el8ELFFWSQ7NSpimh1724762606.png"], "explanation_images": [], "explanation": "<p>Correct Option B - Didelphys Uteru\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following drugs used in the treatment of Multiple Myeloma is associated with an increased risk of developing Herpes zoster infection?", "options": [{"label": "A", "text": "Bortezomib", "correct": true}, {"label": "B", "text": "Daratumumab", "correct": false}, {"label": "C", "text": "Lomitapide", "correct": false}, {"label": "D", "text": "Lenalidomide", "correct": false}], "correct_answer": "A. Bortezomib", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - B\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with a new 2 cm black nodular mass near an episiotomy scar that is painful and expands during menstruation. What is the most likely cause?", "options": [{"label": "A", "text": "Endometriosis", "correct": true}, {"label": "B", "text": "Melanoma", "correct": false}, {"label": "C", "text": "Foreign body granuloma", "correct": false}, {"label": "D", "text": "Inclusion cyst", "correct": false}], "correct_answer": "A. Endometriosis", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A man occasionally eats outside due to traveling reasons. He presents to a physician with abdominal pain for 4 days, along with a history of fever and bradycardia. Which test is used to confirm the diagnosis?", "options": [{"label": "A", "text": "Blood culture", "correct": true}, {"label": "B", "text": "Widal test", "correct": false}, {"label": "C", "text": "Stool culture", "correct": false}, {"label": "D", "text": "Urine culture", "correct": false}], "correct_answer": "A. Blood culture", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/tyfvv5y7n98ZfnmdjpUs1724843174.png"], "explanation": "<p>Correct Option A - Blood cultu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with sudden diminution of vision, difficulty looking towards the light, and circumcorneal congestion with a hypopyon. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Acute conjunctivitis", "correct": false}, {"label": "B", "text": "Acute angle closure glaucoma", "correct": false}, {"label": "C", "text": "Episcleritis", "correct": false}, {"label": "D", "text": "Acute anterior uveitis", "correct": true}], "correct_answer": "D. Acute anterior uveitis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\"&gt;Acute&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"1ba6a9cfe11692777181950edd7a6d\"&gt;anterior&lt;/span&gt; uv\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "TTF-1 immunohistochemical marker is associated with which of the following cancers?", "options": [{"label": "A", "text": "Squamous cell carcinoma", "correct": false}, {"label": "B", "text": "Lung adenocarcinoma", "correct": true}, {"label": "C", "text": "Small cell carcinoma", "correct": false}, {"label": "D", "text": "Large cell carcinoma", "correct": false}], "correct_answer": "B. Lung adenocarcinoma", "question_images": ["https://image.prepladder.com/content/fZhyAPELQsXva2CT3H431724849786.png"], "explanation_images": [], "explanation": "<p>Correct Option B - Lung\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td><strong>Features </strong></td>\n<td><strong>Squamous cell carcinoma </strong></td>\n<td><strong>Adenocarcinoma (M/C) </strong></td>\n<td><strong>Small cell/oat cell carcinoma </strong></td>\n</tr>\n<tr>\n<td>\n<p>Markers </p>\n<p> </p>\n<p>IHC</p>\n</td>\n<td>\n<p>P40</p>\n<p>p63</p>\n</td>\n<td>\n<p>NAPSIN A</p>\n<p>MUC 1</p>\n<p>TTF1</p>\n</td>\n<td>\n<p>Synaptophysin </p>\n<p>Chromograinin</p>\n<p>Bombesin </p>\n<p>NSE </p>\n<p>CD56</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A neonate presents with poor feeding and vomiting, cataract, and acidosis with a positive Benedict's test on urine and negative urinary glucose. Which enzyme is likely defective?", "options": [{"label": "A", "text": "Galactose-1-phosphate uridyl transferase", "correct": true}, {"label": "B", "text": "Aldolase B", "correct": false}, {"label": "C", "text": "Fructokinase", "correct": false}, {"label": "D", "text": "Glucose-6-phosphatase", "correct": false}], "correct_answer": "A. Galactose-1-phosphate uridyl transferase", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Galactose-1-phosphate u\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 30-year-old football player is brought to the emergency department after he collapsed due to sudden cardiac arrest. Based on the biopsy findings of his cardiac tissue, what is the most likely cause of his death?", "options": [{"label": "A", "text": "Hypertrophic obstructive cardiomyopathy", "correct": true}, {"label": "B", "text": "Dilated cardiomyopathy", "correct": false}, {"label": "C", "text": "Restrictive cardiomyopathy", "correct": false}, {"label": "D", "text": "Arrhythmogenic cardiomyopathy", "correct": false}], "correct_answer": "A. Hypertrophic obstructive cardiomyopathy", "question_images": ["https://image.prepladder.com/content/fchKctLx2qz5Rh9EirZB1724761362.png"], "explanation_images": ["https://image.prepladder.com/content/hBXMYvS6kVNEwEbJXfse1724761465.png", "https://image.prepladder.com/content/BD3XHpfbqGsIFgZksBDU1724761483.png"], "explanation": "<p>Correct Option A - Hypertrophic obstructive cardiomyopath\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What type of dressing is used to cover this post burn wound?", "options": [{"label": "A", "text": "Split thickness skin graft", "correct": true}, {"label": "B", "text": "Full thickness skin graft", "correct": false}, {"label": "C", "text": "VAC dressing", "correct": false}, {"label": "D", "text": "Normal sumag dressing", "correct": false}], "correct_answer": "A. Split thickness skin graft", "question_images": ["https://image.prepladder.com/content/wWAmE5r18400BY9FsLSi1724851697.png"], "explanation_images": ["https://image.prepladder.com/content/RwI2u0WgTNlBsDaewcNf1724851709.png"], "explanation": "<p>Correct Option A - Split &lt;span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\"&gt;thickness&lt;/span&gt; skin g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient's relatives sent a message on social media to the consulting doctor. He is unaware of the other investigations. However, he mentioned that urinary Coproporphyrin is positive. What is the probable cause?", "options": [{"label": "A", "text": "Lead poisoning", "correct": true}, {"label": "B", "text": "Asbestosis", "correct": false}, {"label": "C", "text": "Silicosis", "correct": false}, {"label": "D", "text": "Mercury poisoning", "correct": false}], "correct_answer": "A. Lead poisoning", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/HAaX5tCwgFATHaOXnoZT1724848825.png", "https://image.prepladder.com/content/FscqnbSTC3ySjwKT1ZlX1724848836.png"], "explanation": "<p>Correct Option A - Lead poisoning\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The covering of an omphalocele is derived from which layer?", "options": [{"label": "A", "text": "Amnion", "correct": true}, {"label": "B", "text": "Chorion", "correct": false}, {"label": "C", "text": "Mesoderm", "correct": false}, {"label": "D", "text": "Endoderm", "correct": false}], "correct_answer": "A. Amnion", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - A\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following beta-adrenergic blockers used in the treatment of chronic heart failure (CHF) is known to prolong survival?", "options": [{"label": "A", "text": "Bisoprolol", "correct": true}, {"label": "B", "text": "Labetalol", "correct": false}, {"label": "C", "text": "Propranolol", "correct": false}, {"label": "D", "text": "Atenolol", "correct": false}], "correct_answer": "A. Bisoprolol", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - B\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a patient with type 1 diabetes at the 3rd stage of beta cell damage, which of the following conditions is most likely to be observed?", "options": [{"label": "A", "text": "Autoimmune positive + normoglycemia", "correct": false}, {"label": "B", "text": "Autoimmune negative + normoglycemia", "correct": false}, {"label": "C", "text": "Autoimmune positive + dysglycemia", "correct": true}, {"label": "D", "text": "Autoimmune negative + dysglycemia", "correct": false}], "correct_answer": "C. Autoimmune positive + dysglycemia", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"96ab11a06a16927771823151c8e471\"&gt;Autoimmune&lt;/span&gt; positive + dysg\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with dermatitis, dementia, and cognitive decline. Which micronutrient deficiency is most likely responsible?", "options": [{"label": "A", "text": "Niacin", "correct": false}, {"label": "B", "text": "Thiamine", "correct": false}, {"label": "C", "text": "Tryptophan", "correct": false}, {"label": "D", "text": "Riboflavin", "correct": true}], "correct_answer": "D. Riboflavin", "question_images": [], "explanation_images": ["https://image.prepladder.com/notes/FI0x8jLzyUiJr0AQuSJ51745228674.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which tongue papillae does not have taste buds?", "options": [{"label": "A", "text": "Fungiform", "correct": false}, {"label": "B", "text": "Filiform", "correct": true}, {"label": "C", "text": "Circumvallate", "correct": false}, {"label": "D", "text": "Foliate", "correct": false}], "correct_answer": "B. Filiform", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/TpAwP8UMgpJNxZBh0ZeN1724909253.png"], "explanation": "<p>Correct Option B - F\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Papilla Type</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Location</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p style=\"text-align: center;\"><strong>Number of Taste Buds</strong></p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Fungiform Papilla</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Tongue’s tip</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Upto 5</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Foliate Papilla</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Two <span class=\"customMeta\" data-dictid=\"fc380e21321692777191739bd99191\">lateral</span> ends of the tongue</p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Upto 100</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\"><strong>Circumvallate Papilla</strong></td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">The base of the tongue</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">Upto 100 (max)</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with decreased vision three years after surgery and exhibits this condition. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Pseudo-bullous keratopathy", "correct": false}, {"label": "B", "text": "Corneal dystrophy", "correct": false}, {"label": "C", "text": "Posterior subcapsular cataract", "correct": false}, {"label": "D", "text": "Posterior capsular opacification (PCO)", "correct": true}], "correct_answer": "D. Posterior capsular opacification (PCO)", "question_images": ["https://image.prepladder.com/content/CginjMiduVaQSUnPIlbA1724830620.png"], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"a5c6cb079d16927771967e62ffee72\"&gt;Posterior&lt;/span&gt; capsular &lt;span class=\"customMeta\" data-dictid=\"990cbfd3111692777194c6967ee125\"&gt;opacification&lt;/span&gt; (PCO)\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is the tumor marker for ovarian solid cystic mass in a 20 year old female?", "options": [{"label": "A", "text": "Ca125, AFP,HCG,CEA", "correct": false}, {"label": "B", "text": "Ca125, AFP,HCG,Ca 19.9", "correct": false}, {"label": "C", "text": "Ca125, AFP, HCG, LDH", "correct": true}, {"label": "D", "text": "Ca125, AFP,HCG,Ca 15.3", "correct": false}], "correct_answer": "C. Ca125, AFP, HCG, LDH", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/iDW9F1ANIL88TlETfsQs1724828171.png"], "explanation": "<p>Correct Option C - Ca125, AFP, HCG, LDH\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 40-year-old farmer presents with retro-orbital pain, burning red eyes, conjunctival suffusion, fever with chills, calf tenderness, and joint pain. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Dengue", "correct": false}, {"label": "B", "text": "Malaria", "correct": false}, {"label": "C", "text": "Leptospirosis", "correct": true}, {"label": "D", "text": "Filariasis", "correct": false}], "correct_answer": "C. Leptospirosis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/8FYB2ATkL78EaYLiYnDC1724745744.png"], "explanation": "<p>Correct Option C - L\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 5-year-old unimmunized child presents to the OPD with a fully immunized 2-year-old sibling. Upon inspection, a white membranous layer is observed in the throat of the 5-year-old. What is the next step in management for the contact?", "options": [{"label": "A", "text": "Diphtheria toxoid bolus", "correct": false}, {"label": "B", "text": "Diphtheria toxin", "correct": false}, {"label": "C", "text": "Penicillin", "correct": true}, {"label": "D", "text": "No treatment is needed", "correct": false}], "correct_answer": "C. Penicillin", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the maneuver shown in the image.", "options": [{"label": "A", "text": "Burn-Marshall Maneuver", "correct": true}, {"label": "B", "text": "Lovset Maneuver", "correct": false}, {"label": "C", "text": "Mauriceau-Smellie-Veit Maneuver", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "A. Burn-Marshall Maneuver", "question_images": ["https://image.prepladder.com/content/LkVssqADrzVbD5isnJK21724934996.png"], "explanation_images": ["https://image.prepladder.com/content/dGAnsBTowGo7S69VxrkG1724828458.png", "https://image.prepladder.com/content/mnqR3pJWEXxI6ZIB9Kzd1724828584.png", "https://image.prepladder.com/content/5pS7Lq9fz3m0tZ5xh1Jw1724825189.png"], "explanation": "<p>Correct Option A - Burn-Marshall Maneuv\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "27 weeks of gestation with congenital anomalies. whose presence is not required for authorisation of MTP?", "options": [{"label": "A", "text": "Obstetrician", "correct": false}, {"label": "B", "text": "Lawyer", "correct": true}, {"label": "C", "text": "Pediatrician", "correct": false}, {"label": "D", "text": "Sonologist", "correct": false}], "correct_answer": "B. Lawyer", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - L\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient from a military background presents with fever, a rash, and neck rigidity. Laboratory investigations reveal a lack of membrane-attacking complex. What is the most likely causative agent?", "options": [{"label": "A", "text": "Neisseria meningitidis", "correct": true}, {"label": "B", "text": "Neisseria gonorrhoea", "correct": false}, {"label": "C", "text": "Klebsiella", "correct": false}, {"label": "D", "text": "CMV", "correct": false}], "correct_answer": "A. Neisseria meningitidis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Neisseria mening\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child presented with anemia, mental retardation, bone pains, and hepatosplenomegaly. Bone marrow biopsy showed a \"crumpled tissue paper\" appearance. What is the enzyme deficiency producing this condition?", "options": [{"label": "A", "text": "Hexosaminidase-A", "correct": false}, {"label": "B", "text": "Iduronate 2-sulphatase", "correct": false}, {"label": "C", "text": "Glucose-6-phosphate dehydrogenase", "correct": false}, {"label": "D", "text": "Glucocerebrosidase", "correct": true}], "correct_answer": "D. Glucocerebrosidase", "question_images": ["https://image.prepladder.com/content/lQzpjaNb7G842C75wgZh1724824090.png"], "explanation_images": [], "explanation": "<p>Correct Option D – Glu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A jeep driver presented with pain in the gluteal region along with swelling. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Pilonidal sinus", "correct": true}, {"label": "B", "text": "Fistula in ano", "correct": false}, {"label": "C", "text": "Fissure in ano", "correct": false}, {"label": "D", "text": "Gluteal abscess", "correct": false}], "correct_answer": "A. Pilonidal sinus", "question_images": ["https://image.prepladder.com/content/iyh42yuThung6rt7Wo5z1724928909.png"], "explanation_images": ["https://image.prepladder.com/content/FgA02lUhVnAquyWUUesc1724851763.png"], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"03c4278aff1692777195f7a3d87815\"&gt;Pilonidal&lt;/span&gt; sinu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A pulmonary artery hypertension patient presented with an irregularly irregular pulse with loud P2 on auscultation. Which JVP finding will be seen in this patient?", "options": [{"label": "A", "text": "Absent a waves", "correct": true}, {"label": "B", "text": "Cannon a waves", "correct": false}, {"label": "C", "text": "Rapid x descent", "correct": false}, {"label": "D", "text": "Rapid y descent", "correct": false}], "correct_answer": "A. Absent a waves", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Absent a wav\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient’s X-ray shows cardiomegaly, and they present with a \"floppy baby\" syndrome, hypotonia, macroglossia, and hepatomegaly. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Pompe disease", "correct": true}, {"label": "B", "text": "Ebstein anomaly", "correct": false}, {"label": "C", "text": "Down syndrome", "correct": false}, {"label": "D", "text": "Cori's Disease", "correct": false}], "correct_answer": "A. Pompe disease", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - P\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 38-year-old patient with hypopigmented nodular lesions with anethesia over arm with ulnar nerve involvement underwent a biopsy and intradermal antigen test. Based on the image, which statement regarding the condition is most accurate?", "options": [{"label": "A", "text": "Tuberculoid leprosy with a positive antigen test", "correct": false}, {"label": "B", "text": "Lepromatous leprosy with a positive antigen test", "correct": false}, {"label": "C", "text": "Erythema nodosum leprosum with a negative antigen test", "correct": false}, {"label": "D", "text": "Lepromatous leprosy with a negative antigen test", "correct": true}], "correct_answer": "D. Lepromatous leprosy with a negative antigen test", "question_images": ["https://image.prepladder.com/content/3RAoUBNPO4IPT6BBBNww1724752791.png"], "explanation_images": ["https://image.prepladder.com/content/VPIMSCGmZYeAqOiqsRFW1724851952.png", "https://image.prepladder.com/content/8rnvIDDBT6Du18NpxBdf1724851924.png"], "explanation": "<table>\n<thead>\n<tr>\n<th>Feature</th>\n<th>Description</th>\n</tr>\n</thead>\n<tbody>\n<tr>\n<td>Skin lesions</td>\n<td>Numerous, symmetric, poorly defined, <span class=\"customMeta\" data-dictid=\"bfa856c77716927771939978c5afd0\">nodular</span> or macular</td>\n</tr>\n<tr>\n<td>Sensory loss</td>\n<td>Late, diffuse</td>\n</tr>\n<tr>\n<td>Nerve involvement</td>\n<td>Multiple nerves, symmetrically</td>\n</tr>\n<tr>\n<td>Immune response</td>\n<td>Weak or absent <span class=\"customMeta\" data-dictid=\"5eb50cf561169277718491671207db\">cell-mediated immunity</span> (CMI)</td>\n</tr>\n<tr>\n<td>Lepromin (Mitsuda) test</td>\n<td><strong>Negative</strong> (due to poor CMI)</td>\n</tr>\n<tr>\n<td>Bacillary load</td>\n<td>High</td>\n</tr>\n<tr>\n<td>Histopathology</td>\n<td>Numerous <span class=\"customMeta\" data-dictid=\"440f2b916316927771808b8ad44a64\">acid-fast</span> bacilli, foamy macrophages</td>\n</tr>\n</tbody>\n\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A pregnant woman presents with a history suggestive of hyperthyroidism at 8 weeks of gestation (POG). What is the drug of choice?", "options": [{"label": "A", "text": "Propylthiouracil (PTU)", "correct": true}, {"label": "B", "text": "Methimazole", "correct": false}, {"label": "C", "text": "Carbimazole", "correct": false}, {"label": "D", "text": "Propranolol", "correct": false}], "correct_answer": "A. Propylthiouracil (PTU)", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"34735bff271692777196f13335f804\"&gt;Propylthiouracil&lt;/span&gt; (PTU)\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 60-year-old lady presents with SOB and angina pectoris episodes. Work up shows aortic stenosis. Which of the following is the reason behind these chest pain episodes?", "options": [{"label": "A", "text": "Increased pressure in aorta", "correct": false}, {"label": "B", "text": "Decreased pressure in aorta", "correct": false}, {"label": "C", "text": "Increased oxygen consumption in heart", "correct": true}, {"label": "D", "text": "Increase in volume overload of heart", "correct": false}], "correct_answer": "C. Increased oxygen consumption in heart", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Increased &lt;span class=\"customMeta\" data-dictid=\"72d435bfb11692777194f88fdb0bf3\"&gt;oxygen consumption&lt;/span&gt; in the h\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with joint swelling, a pan systolic murmur, negative rheumatoid factor (RF), and elevated ESR. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Acute rheumatic fever", "correct": true}, {"label": "B", "text": "Seronegative rheumatoid arthritis (RA)", "correct": false}, {"label": "C", "text": "Juvenile spondyloarthropathy", "correct": false}, {"label": "D", "text": "Ankylosing spondylitis", "correct": false}], "correct_answer": "A. Acute rheumatic fever", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"4cdc8161f71692777180df58cafa93\"&gt;Acute&lt;/span&gt; rheumatic fev\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following substances should be eaten to prevent thiamine deficiency?", "options": [{"label": "A", "text": "Rice and wheat", "correct": true}, {"label": "B", "text": "Curd", "correct": false}, {"label": "C", "text": "Salad", "correct": false}, {"label": "D", "text": "Sabji (Aloo)", "correct": false}], "correct_answer": "A. Rice and wheat", "question_images": ["https://image.prepladder.com/content/oHJAbrtiZdznNgiftk811724845734.png"], "explanation_images": ["https://image.prepladder.com/content/s7LazMxsJwuvZ72blU8X1724845848.png"], "explanation": "<p>Correct Option A - Rice and wh\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the degree of tear shown below?", "options": [{"label": "A", "text": "1st degree", "correct": false}, {"label": "B", "text": "2nd degree", "correct": false}, {"label": "C", "text": "3rd degree", "correct": true}, {"label": "D", "text": "4th degree", "correct": false}], "correct_answer": "C. 3rd degree", "question_images": ["https://image.prepladder.com/content/zK7ZggUJTFP7mUYD1zgC1724760189.png"], "explanation_images": ["https://image.prepladder.com/content/ZKWm9wBuKIO7C5RqxQ3q1724828034.png"], "explanation": "<p>Correct Option C - 3rd Deg\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with no pulse, and the ECG shows the following rhythm. What is the next appropriate step?", "options": [{"label": "A", "text": "Defibrillate, check pulse and then perform CPR", "correct": false}, {"label": "B", "text": "Cardioversion", "correct": false}, {"label": "C", "text": "Defibrillate, perform CPR, and then check the pulse", "correct": true}, {"label": "D", "text": "Administer epinephrine", "correct": false}], "correct_answer": "C. Defibrillate, perform CPR, and then check the pulse", "question_images": ["https://image.prepladder.com/content/mkiO5g8IgXuGwaqLGg5M1724762158.png"], "explanation_images": ["https://image.prepladder.com/content/ZLzfHKBfr899gibcBPcE1724821415.png"], "explanation": "<p>Correct Option C - Defibrillate, perform CPR, and then check the pu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "To study the effect of vitamin C on respiratory disease pre-post study is done. Arrange in the correct sequence. A. Select case and control. B. Matching C. Measure total exposure D. Analysis", "options": [{"label": "A", "text": "ABCD", "correct": true}, {"label": "B", "text": "BCDA", "correct": false}, {"label": "C", "text": "CBAD", "correct": false}, {"label": "D", "text": "DABC", "correct": false}], "correct_answer": "A. ABCD", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/PkF33UbLKFngvlcnvEF61724845621.png"], "explanation": "<p>Correct Option A - ABCD\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/Zxw0fZ9bsf1qPT6iAC6X1746263615.mp3", "video": ""}, {"text": "A child presents to the outpatient department (OPD) with a radiological image as given. What is the most appropriate management for this condition?", "options": [{"label": "A", "text": "Endoscopic ablation", "correct": true}, {"label": "B", "text": "Dilation of urethra", "correct": false}, {"label": "C", "text": "Dilation of urethra and bladder", "correct": false}, {"label": "D", "text": "Conservative", "correct": false}], "correct_answer": "A. Endoscopic ablation", "question_images": ["https://image.prepladder.com/content/U9he1HdNok4QPF2T9MVy1724937059.png"], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"35ca8c2d5f16927771879351e8f97e\"&gt;Endoscopic&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 35 year old female presented with lesion below shown. This would result in which kind of field abnormality?", "options": [{"label": "A", "text": "Homonymous hemianopia", "correct": false}, {"label": "B", "text": "Bitemporal hemianopia", "correct": true}, {"label": "C", "text": "Complete blindness", "correct": false}, {"label": "D", "text": "Single vision field loss", "correct": false}], "correct_answer": "B. Bitemporal hemianopia", "question_images": ["https://image.prepladder.com/content/aU27nrhSbdxn5ITPdC0T1724830232.png"], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"3b17da47ce16927771831d5dde3af3\"&gt;Bitemporal&lt;/span&gt; h\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents to the emergency room with severe abdominal pain, and serum triglyceride levels are 1500 mg/dL. What is the most likely underlying defect?", "options": [{"label": "A", "text": "Apo B-48 defect", "correct": false}, {"label": "B", "text": "Apo B-100 defect", "correct": false}, {"label": "C", "text": "Apo C-II defect", "correct": true}, {"label": "D", "text": "LDL receptor defect", "correct": false}], "correct_answer": "C. Apo C-II defect", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Apo C-II\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which vitamin is to be supplemented in a patient following gastrectomy?", "options": [{"label": "A", "text": "Vitamin A", "correct": false}, {"label": "B", "text": "Vitamin B1", "correct": false}, {"label": "C", "text": "Vitamin C", "correct": false}, {"label": "D", "text": "Vitamin B12", "correct": true}], "correct_answer": "D. Vitamin B12", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Vitamin B12\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A man experiences sexual arousal from wearing female undergarments and high heels during sexual activity with women, but he is not attracted to men. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Gender Dysphoria", "correct": false}, {"label": "B", "text": "Transvestic Fetishism", "correct": true}, {"label": "C", "text": "Hermaphroditism", "correct": false}, {"label": "D", "text": "Gay Identity Disorder", "correct": false}], "correct_answer": "B. Transvestic Fetishism", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"5f6a6bae2a1692777200a3a754073a\"&gt;Transvestic&lt;/span&gt; Fetish\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the grade of the condition given in the image below ?", "options": [{"label": "A", "text": "Grade 1", "correct": false}, {"label": "B", "text": "Grade 2", "correct": false}, {"label": "C", "text": "Grade 3", "correct": false}, {"label": "D", "text": "Grade 4", "correct": true}], "correct_answer": "D. Grade 4", "question_images": ["https://image.prepladder.com/content/ODOgGHyTvDAsiJC3b8nw1724850417.png"], "explanation_images": ["https://image.prepladder.com/content/anwVJpHL60gRf0iuPMqC1724850431.png", "https://image.prepladder.com/content/VnsXYMAF9YnMtrtwGLj91724850443.png", "https://image.prepladder.com/content/GycEf6jMWmjZ145MROfd1724850465.png", "https://image.prepladder.com/content/BZ7u6Uu9MYEc09qkOzXE1724850480.png"], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"d4ae50897e16927771884b5c46ba7d\"&gt;Grade&lt;/span&gt; 4\n<table align=\"left\">\n<tbody>\n<tr>\n<td style=\"border-bottom:none; border-left:none; border-right:1px solid black; border-top:3px double black\">\n<p style=\"text-align: center;\"><strong>Stage I</strong></p>\n</td>\n<td style=\"border-bottom:none; border-left:none; border-right:1px solid black; border-top:3px double black\">\n<p style=\"text-align: center;\"><strong>Stage II</strong></p>\n</td>\n<td style=\"border-bottom:none; border-left:none; border-right:1px solid black; border-top:3px double black\">\n<p style=\"text-align: center;\"><strong>Stage III</strong></p>\n</td>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:3px double black\">\n<p style=\"text-align: center;\"><strong>Stage IV</strong></p>\n</td>\n</tr>\n<tr>\n<td colspan=\"1\" rowspan=\"6\" style=\"border-bottom:none; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Non <span class=\"customMeta\" data-dictid=\"79f30e93e41692777183d60fdfa512\">blanchable erythema</span> of skin without breach in epidermis</li>\n<li>Early <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> ulcer</li>\n</ul>\n</td>\n<td colspan=\"1\" rowspan=\"6\" style=\"border-bottom:none; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Partial <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> less including <span class=\"customMeta\" data-dictid=\"e4c62a77731692777187b9c7ded25d\">epidermis</span> + dermis.</li>\n<li>Late <span class=\"customMeta\" data-dictid=\"ebb480187d1692777199e233e9e356\">superficial</span> ulcer</li>\n</ul>\n</td>\n<td colspan=\"1\" rowspan=\"6\" style=\"border-bottom:none; border-left:none; border-right:1px solid black; border-top:none\">\n<ul>\n<li>Full <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> skin loss involving <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> through underlying fasica.</li>\n<li>Early deep ulcer</li>\n</ul>\n</td>\n<td colspan=\"1\" rowspan=\"6\">\n<ul>\n<li>Full <span class=\"customMeta\" data-dictid=\"facd67f6341692777200653d383689\">thickness</span> skin loss involving <span class=\"customMeta\" data-dictid=\"d446e62c6c1692777199896fc1d4b9\">subcutaneous</span> tissue, muscle tendon.</li>\n<li>Late deep ulcer</li>\n</ul>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which micronutrient deficiency causes anemia, bleeding gums, and Frenkel’s white line on X-ray?", "options": [{"label": "A", "text": "Vitamin K", "correct": false}, {"label": "B", "text": "Vitamin A", "correct": false}, {"label": "C", "text": "Vitamin C", "correct": true}, {"label": "D", "text": "Vitamin E", "correct": false}], "correct_answer": "C. Vitamin C", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - Vitamin C\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the index?", "options": [{"label": "A", "text": "Human developmental index", "correct": true}, {"label": "B", "text": "POLI", "correct": false}, {"label": "C", "text": "Human poverty index", "correct": false}, {"label": "D", "text": "Multidimensional poverty index", "correct": false}], "correct_answer": "A. Human developmental index", "question_images": ["https://image.prepladder.com/content/5x6uaT7PdRILpeca8xnI1724850212.png"], "explanation_images": ["https://image.prepladder.com/content/rJQQDgb38pwVk7uACUBn1724850965.png"], "explanation": "<p>Correct Option A - Human dev\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Examination of a suspicious stain shows the following finding. The test is?", "options": [{"label": "A", "text": "Barberios test", "correct": true}, {"label": "B", "text": "Florence test", "correct": false}, {"label": "C", "text": "Teichman test", "correct": false}, {"label": "D", "text": "Takayama test", "correct": false}], "correct_answer": "A. Barberios test", "question_images": ["https://image.prepladder.com/content/JtageTDyIWzePdEjVEog1724827232.png"], "explanation_images": [], "explanation": "<p>Correct Option A - B\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with a history of ear discharge. On examination, a small perforation is observed in the antero-inferior segment of the tympanic membrane. What is the most likely result of Rinne’s test?", "options": [{"label": "A", "text": "Rinne’s positive", "correct": false}, {"label": "B", "text": "Rinne’s negative", "correct": true}, {"label": "C", "text": "Rinne’s equivocal", "correct": false}, {"label": "D", "text": "Cannot be determined", "correct": false}], "correct_answer": "B. Rinne’s negative", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Rinne’s negativ\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which sinus drainage is obstructed in the image provided?", "options": [{"label": "A", "text": "Maxillary", "correct": true}, {"label": "B", "text": "Ethmoid", "correct": false}, {"label": "C", "text": "Sphenoid", "correct": false}, {"label": "D", "text": "Frontal", "correct": false}], "correct_answer": "A. Maxillary", "question_images": ["https://image.prepladder.com/content/y9rNFaiYLgEvqg023g9w1724840438.png"], "explanation_images": [], "explanation": "<p>Correct Option A - M\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A teenage girl presents with a history of primary amenorrhea. On physical examination, an imperforate hymen is observed. What karyotype analysis would you consider for further evaluation?", "options": [{"label": "A", "text": "46XY", "correct": false}, {"label": "B", "text": "46XX", "correct": true}, {"label": "C", "text": "45XO", "correct": false}, {"label": "D", "text": "47XXY", "correct": false}], "correct_answer": "B. 46XX", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - 46XX\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old patient presents with ptosis and muscle weakness that improves with rest. She also complains of dysphagia and has engorged veins in her thorax. Based on the CT scan image provided, what is the most likely diagnosis?", "options": [{"label": "A", "text": "Thymoma", "correct": true}, {"label": "B", "text": "Pancoast tumor", "correct": false}, {"label": "C", "text": "Adenocarcinoma", "correct": false}, {"label": "D", "text": "Small cell lung cancer", "correct": false}], "correct_answer": "A. Thymoma", "question_images": ["https://image.prepladder.com/content/rmESN6H1zuIWTS6E6ZlG1724744195.png"], "explanation_images": [], "explanation": "<p>Correct Option A – Th\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which organism is associated with broad-based budding?", "options": [{"label": "A", "text": "Sporothrix schenckii", "correct": false}, {"label": "B", "text": "Blastomyces", "correct": true}, {"label": "C", "text": "Talaromyces marneffei", "correct": false}, {"label": "D", "text": "Paracoccidioidomycosis", "correct": false}], "correct_answer": "B. Blastomyces", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/Jrn1o9mCJi4vszZ2X2Rp1724837216.png"], "explanation": "<p>Correct Option B - B\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 6-week-old child is brought to the emergency department with recurrent projectile, non-bilious vomiting. Based on the radiograph provided, what is the most likely diagnosis?", "options": [{"label": "A", "text": "Annular pancreas", "correct": false}, {"label": "B", "text": "Congenital Hypertrophic Pyloric Stenosis", "correct": true}, {"label": "C", "text": "Duodenal atresia", "correct": false}, {"label": "D", "text": "Meckel’s diverticulum", "correct": false}], "correct_answer": "B. Congenital Hypertrophic Pyloric Stenosis", "question_images": ["https://image.prepladder.com/content/xCv95fuJEO6r0S6bCEaX1724744632.png"], "explanation_images": ["https://image.prepladder.com/content/Na2uM1dqsyTv9Sn2ERli1724744764.png"], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\"&gt;Congenital&lt;/span&gt; Hypertrophic Pyloric S\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following prevents polyspermy?", "options": [{"label": "A", "text": "Acrosome reaction", "correct": false}, {"label": "B", "text": "Cortical reaction", "correct": true}, {"label": "C", "text": "Zona reaction", "correct": false}, {"label": "D", "text": "Capacitation", "correct": false}], "correct_answer": "B. Cortical reaction", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"721937292f1692777185048f04ce29\"&gt;Cortical&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with features of hyperthyroidism, characterized by decreased TSH levels and elevated free T3 and T4. Which of the following statements about this condition is NOT true?", "options": [{"label": "A", "text": "The condition will improve simultaneously with improvement in the thyrotoxic state.", "correct": true}, {"label": "B", "text": "In 10% of cases, the condition is present without hyperthyroidism.", "correct": false}, {"label": "C", "text": "Severe disease can cause vision loss.", "correct": false}, {"label": "D", "text": "No specs criteria is used for this condition.", "correct": false}], "correct_answer": "A. The condition will improve simultaneously with improvement in the thyrotoxic state.", "question_images": ["https://image.prepladder.com/content/EFx8kucFM0omR1tjX3yV1724925500.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In a patient of hereditary spherocytosis, which of the following organisms is likely to attack progenitor cells, resulting in aplastic anemia?", "options": [{"label": "A", "text": "CMV", "correct": false}, {"label": "B", "text": "EBV", "correct": false}, {"label": "C", "text": "Parvovirus B19", "correct": true}, {"label": "D", "text": "HSV", "correct": false}], "correct_answer": "C. Parvovirus B19", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"4c37b9980316927771941adbff3e43\"&gt;Parvovirus&lt;/span&gt; B19\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Caffeine impairs with sleep by which of the following:", "options": [{"label": "A", "text": "Blocks adenosine action and wakefulness", "correct": true}, {"label": "B", "text": "Activate locus coeruleus and wakefulness", "correct": false}, {"label": "C", "text": "No role in maintaining wakefulness", "correct": false}, {"label": "D", "text": "Activates histamine release and prevent sleep.", "correct": false}], "correct_answer": "A. Blocks adenosine action and wakefulness", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/BNMcstxtVIi3dRyAWB751724909318.png"], "explanation": "\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The nerve passing through the red arrow marked region has been lesioned. Which of the following will be the clinical presentation?", "options": [{"label": "A", "text": "Loss of sensation in the mucosa of nasopharynx", "correct": false}, {"label": "B", "text": "Loss of sensation in maxillary area of face", "correct": false}, {"label": "C", "text": "Loss of sensation in jaw area", "correct": false}, {"label": "D", "text": "Loss of sensation in scalp and nose", "correct": true}], "correct_answer": "D. Loss of sensation in scalp and nose", "question_images": ["https://image.prepladder.com/content/hesLTOIZA7NfAxBRxXi31726836158.png"], "explanation_images": ["https://image.prepladder.com/content/iPeorruCaHaCTwQD6sEB1727178229.png"], "explanation": "<p>Correct Option D - Loss of sensation in &lt;span class=\"customMeta\" data-dictid=\"038a2a2fd4169277719894dc7db4bb\"&gt;scalp&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient with high triglycerides esterified with long-chain fatty acids presents with fatigue, and muscle biopsy shows fat vacuoles. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Carnitine deficiency", "correct": true}, {"label": "B", "text": "Fatty Acid Synthase defect", "correct": false}, {"label": "C", "text": "Lipoprotein Lipase (LPL) deficiency", "correct": false}, {"label": "D", "text": "Medium-chain acyl-CoA dehydrogenase (MCAD) deficiency", "correct": false}], "correct_answer": "A. Carnitine deficiency", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - C\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Diagnose the condition using the histological image provided.", "options": [{"label": "A", "text": "Morphea", "correct": true}, {"label": "B", "text": "Lichen nitidus", "correct": false}, {"label": "C", "text": "Lichen planus", "correct": false}, {"label": "D", "text": "Lichen amyloidosis", "correct": false}], "correct_answer": "A. Morphea", "question_images": ["https://image.prepladder.com/content/EdsUYXenJGButdxCwqT01724752990.png"], "explanation_images": ["https://image.prepladder.com/content/GzclwLHkjBurrU4Jnhit1724852011.png", "https://image.prepladder.com/content/X4TlPqzaeTXfWY8lMi2E1727178792.jpg", "https://image.prepladder.com/content/pluBjPFgjIVHiV2VNAnq1727178828.jpg"], "explanation": "<p>Correct option A - Morph\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the preferred method of delivery in A cephalic lie and B cephalic lie?", "options": [{"label": "A", "text": "LSCS, vaginal", "correct": false}, {"label": "B", "text": "Vaginal, LSCS", "correct": false}, {"label": "C", "text": "Normal delivery in both", "correct": true}, {"label": "D", "text": "LSCS in both", "correct": false}], "correct_answer": "C. Normal delivery in both", "question_images": ["https://image.prepladder.com/content/ZlQsFOahXFwTWtY1x24A1724756150.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is deficient in a patient with phenylketionuria with normal phenyl alanine hydroxylase levels?", "options": [{"label": "A", "text": "Tyrosine transaminase", "correct": false}, {"label": "B", "text": "Dopa decarboxylase", "correct": false}, {"label": "C", "text": "Tyrosine hydroxylase", "correct": false}, {"label": "D", "text": "Dihydrobiopterine reductase", "correct": true}], "correct_answer": "D. Dihydrobiopterine reductase", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/B6nQ2M5vnP7lJOFsJiRv1724848454.png"], "explanation": "<p>Correct Option D - Dihydrobiopterine redu\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A statistician wants to study the effects of medicine in three groups: humans, animals, and plants. He selects randomly out of these three groups. Which type of sampling is performed here?", "options": [{"label": "A", "text": "Simple Random Sampling", "correct": false}, {"label": "B", "text": "Systematic Sampling", "correct": false}, {"label": "C", "text": "Stratified Random Sampling", "correct": true}, {"label": "D", "text": "Cluster Sampling", "correct": false}], "correct_answer": "C. Stratified Random Sampling", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/FVIxs57ZKent0DYCauzH1724759902.png"], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"e2f163c4cd1692777199def45e74f1\"&gt;Stratified&lt;/span&gt; Random Sampling\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which drug is used to reverse the muscle relaxant effects of vecuronium when renal function is normal?", "options": [{"label": "A", "text": "Sugammadex", "correct": true}, {"label": "B", "text": "Neostigmine", "correct": false}, {"label": "C", "text": "Atropine", "correct": false}, {"label": "D", "text": "Physostigmine", "correct": false}], "correct_answer": "A. Sugammadex", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Sug\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Select the correct option regarding the function of receptors?", "options": [{"label": "A", "text": "Ruffini corpuscle - Sustained pressure", "correct": false}, {"label": "B", "text": "Merkel cells - stretching", "correct": false}, {"label": "C", "text": "Meissner’s corpuscle - deep pressure", "correct": false}, {"label": "D", "text": "Pacinian corpuscle - Vibration", "correct": true}], "correct_answer": "D. Pacinian corpuscle - Vibration", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Pacinian &lt;span class=\"customMeta\" data-dictid=\"7c014f0a121692777185a3c89b4e6a\"&gt;corpuscle&lt;/span&gt; - V\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A group of 80 people was studied to assess the effect of diet modification on mean cholesterol levels before and after the intervention. Which statistical test is most appropriate to compare the mean cholesterol levels before and after the diet modification?", "options": [{"label": "A", "text": "Paired t-test", "correct": true}, {"label": "B", "text": "McNemar test", "correct": false}, {"label": "C", "text": "Chi-square test", "correct": false}, {"label": "D", "text": "Wilcoxon signed-rank test", "correct": false}], "correct_answer": "A. Paired t-test", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/5XoKarV5Cxr5ZKnY8sXV1724843245.png"], "explanation": "<p>Correct Option A - P\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the structure marked with the arrow in the diagram provided:", "options": [{"label": "A", "text": "Arrector pili", "correct": false}, {"label": "B", "text": "Sebaceous gland", "correct": true}, {"label": "C", "text": "Sweat gland", "correct": false}, {"label": "D", "text": "Hair papilla", "correct": false}], "correct_answer": "B. Sebaceous gland", "question_images": ["https://image.prepladder.com/content/xb3GPyrLSZ13rEq80BBH1724752358.png"], "explanation_images": ["https://image.prepladder.com/content/xPirY8KcLF3Ax4jnK5Kp1724851875.png"], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"359edf0778169277719886070af9db\"&gt;Sebaceous&lt;/span&gt; g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female presents at 22 weeks of pregnancy due to rape. Which statement is correct regarding medical termination of pregnancy (MTP)?", "options": [{"label": "A", "text": "Between 20-24 weeks, one doctor’s opinion is required", "correct": false}, {"label": "B", "text": "Between 20-24 weeks, MTP is only done if it is life-saving for the mother", "correct": false}, {"label": "C", "text": "MTP can be done up to 24 weeks in this case", "correct": true}, {"label": "D", "text": "MTP can be done after 24 weeks.", "correct": false}], "correct_answer": "C. MTP can be done up to 24 weeks in this case", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"eb06d1383216927771938c9eadb451\"&gt;MTP&lt;/span&gt; can be done up to 24 weeks in th\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 7-year-old male child presents with a history of recurrent urinary tract infections, poor urinary stream, and failure to thrive. On examination, his abdomen is distended, and there is a palpable bladder. His MCU is given below. What is the next best step in management?", "options": [{"label": "A", "text": "Cystoscopic resection", "correct": true}, {"label": "B", "text": "Urethral reconstruction", "correct": false}, {"label": "C", "text": "Intermittent catheterization", "correct": false}, {"label": "D", "text": "Bladder augmentation surgery", "correct": false}], "correct_answer": "A. Cystoscopic resection", "question_images": ["https://image.prepladder.com/content/pTPfw6B4noHSEh2iFClu1724749835.png"], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"8a8a7309fc169277718529cb457969\"&gt;Cystoscopic&lt;/span&g\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width:100%\">\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\">If <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">creatinine</span> is normal </p>\n<p style=\"text-align: center;\">↓</p>\n<p style=\"text-align: center;\">Endoscopic <span class=\"customMeta\" data-dictid=\"e06e32271216927772030141e67a00\">fulguration</span> of valve </p>\n</td>\n<td>\n<p style=\"text-align: center;\">If <span class=\"customMeta\" data-dictid=\"2ead0fd0301692777185187bd72768\">Creatinine</span> is raised (means there is no effective drainage) </p>\n<p style=\"text-align: center;\">↓</p>\n<p style=\"text-align: center;\">Suprapubic <span class=\"customMeta\" data-dictid=\"f2dde065411692777185f9e915a087\">cystostomy</span> by blockson Technique.</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with 5th metatarsal fracture. For how many days he/she would have to wear cast?", "options": [{"label": "A", "text": "2-3 weeks", "correct": false}, {"label": "B", "text": "3-5 weeks", "correct": false}, {"label": "C", "text": "6-8 weeks", "correct": true}, {"label": "D", "text": "16- 20 weeks", "correct": false}], "correct_answer": "C. 6-8 weeks", "question_images": ["https://image.prepladder.com/content/5Wk9Mka7g8VK08SqVuse1724837644.png"], "explanation_images": [], "explanation": "<p>Correct Option C\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is an indication for adjuvant radiotherapy in oral malignancy after resection and modified radical neck dissection (MRND)?", "options": [{"label": "A", "text": "Extranodal extension", "correct": true}, {"label": "B", "text": "Multiple lymph node metastasis", "correct": false}, {"label": "C", "text": "T3 tumor", "correct": false}, {"label": "D", "text": "Close margin", "correct": false}], "correct_answer": "A. Extranodal extension", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - E\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following diseases has the maximum submerged portion of the iceberg?", "options": [{"label": "A", "text": "Influenza", "correct": true}, {"label": "B", "text": "Chicken pox", "correct": false}, {"label": "C", "text": "Tetanus", "correct": false}, {"label": "D", "text": "Rabies", "correct": false}], "correct_answer": "A. Influenza", "question_images": ["https://image.prepladder.com/content/Abm171q9riyMqHCWV6ia1724842801.png"], "explanation_images": ["https://image.prepladder.com/content/qxA1ErMKfeaXmx9lsr811724842878.png", "https://image.prepladder.com/content/n9GVzg73YJMVbfnlv3LO1724842898.png"], "explanation": "<p>Correct Option A - Influ\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old patient presents with symptoms of anemia, depigmented hair, bleeding gums, and diffuse hair loss. Which of the following mineral deficiencies is most likely associated with this clinical presentation?", "options": [{"label": "A", "text": "Copper", "correct": true}, {"label": "B", "text": "Iron", "correct": false}, {"label": "C", "text": "Fluoride", "correct": false}, {"label": "D", "text": "Zinc", "correct": false}], "correct_answer": "A. Copper", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - C\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\">\n<p>Copper Deficiency</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\">\n<p><strong>Key Clinical Features</strong></p>\n</td>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\">\n<p>Anemia, depigmented hair, <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> gums, <span class=\"customMeta\" data-dictid=\"89275101301692777186567d1912a0\">diffuse</span> hair loss</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\">\n<p><strong>Associated Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\">\n<p>Neurological symptoms (ataxia, neuropathy), osteoporosis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\">\n<p><strong>Anatomical/Physiological Role</strong></p>\n</td>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\">\n<p>Copper is essential for iron metabolism, <span class=\"customMeta\" data-dictid=\"afe514c80616927771928d403a54fa\">melanin</span> production, and <span class=\"customMeta\" data-dictid=\"d215f4a56c16927771842f34a24156\">collagen</span> synthesis.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\">\n<p><strong>Differential Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\">\n<p>Distinguished from iron, fluoride, and <span class=\"customMeta\" data-dictid=\"39ecb6e07416927772029550b7e74a\">zinc</span> deficiencies by the presence of specific symptoms such as depigmented hair and <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> gums.</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\">\n<p><strong>Rationale</strong></p>\n</td>\n<td style=\"border-bottom:none; border-left:none; border-right:none; border-top:none; vertical-align:top\">\n<p>The combination of anemia, depigmented hair, and <span class=\"customMeta\" data-dictid=\"41e858bf2816927771836d46c619b9\">bleeding</span> gums is characteristic of <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> deficiency, as <span class=\"customMeta\" data-dictid=\"7b5fb2b56416927771858f02fd5508\">copper</span> is crucial for several <span class=\"customMeta\" data-dictid=\"11d4157da4169277718762144a4fe7\">enzymatic</span> functions.</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 2-year-old child presents with stable vitals and an ECG showing paroxysmal supraventricular tachycardia (PSVT). Which of the following is the appropriate treatment?", "options": [{"label": "A", "text": "Cardioversion", "correct": false}, {"label": "B", "text": "Adenosine 0.2 mg/kg", "correct": false}, {"label": "C", "text": "Adenosine 0.1 mg/kg", "correct": true}, {"label": "D", "text": "IV Adrenaline", "correct": false}], "correct_answer": "C. Adenosine 0.1 mg/kg", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C - &lt;span class=\"customMeta\" data-dictid=\"d3f6a49b7416927771802124ccddf0\"&gt;Adenosine&lt;/span&gt; 0.1 mg/kg\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Recording of evidence of a female in sexual Assault in court is done in?", "options": [{"label": "A", "text": "Open court proceedings", "correct": false}, {"label": "B", "text": "Closed court proceedings", "correct": true}, {"label": "C", "text": "Hearing on different location", "correct": false}, {"label": "D", "text": "Hearing on camera", "correct": false}], "correct_answer": "B. Closed court proceedings", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Closed court proceeding\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 5-year-old girl was washing her doll with shampoo containing rotenone. Her mother noticed her in unconscious state. Which is inhibited by the above chemical?", "options": [{"label": "A", "text": "NADH dehydrogenase", "correct": true}, {"label": "B", "text": "Succinate dehydrogenase", "correct": false}, {"label": "C", "text": "Cytochrome C", "correct": false}, {"label": "D", "text": "Cytochrome oxidase", "correct": false}], "correct_answer": "A. NADH dehydrogenase", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/W1MFyHVqR2X7TSUNG0KB1724848525.png"], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"70e624dfd41692777193efc364d5b4\"&gt;NADH&lt;/span&gt; dehydrog\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the labeling correctly:", "options": [{"label": "A", "text": "A- Superior vena cava, B- Ascending aorta, C- Pulmonary trunk, D- Descending aorta", "correct": true}, {"label": "B", "text": "A- Ascending aorta, B- Descending aorta, C- Pulmonary trunk, D- Superior vena cava", "correct": false}, {"label": "C", "text": "A- Ascending aorta, B- Superior vena cava, C- Descending aorta, D- Pulmonary trunk,", "correct": false}, {"label": "D", "text": "A- Ascending aorta, B- Superior Vena Cava, C- Pulmonary trunk, D- Descending aorta", "correct": false}], "correct_answer": "A. A- Superior vena cava, B- Ascending aorta, C- Pulmonary trunk, D- Descending aorta", "question_images": ["https://image.prepladder.com/content/xKDLNLWpZbpRp7YdTh8N1727075048.png"], "explanation_images": ["https://image.prepladder.com/content/jXmxdHXIIRgsTwo5e9Bx1727075428.jpg"], "explanation": "<p>Correct Option A - A- , B-Ascending &lt;span class=\"customMeta\" data-dictid=\"ce68eab48a1692777181c719b4344e\"&gt;aorta&lt;/span&gt; , C- &lt;span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\"&gt;Pulmonary&lt;/span&gt; trunk, D- &lt;span class=\"customMeta\" data-dictid=\"0cf8ac70611692777186b133d027f6\"&gt;Descending&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the typical time between fertilization and implantation in human reproduction?", "options": [{"label": "A", "text": "2 days", "correct": false}, {"label": "B", "text": "8 days", "correct": true}, {"label": "C", "text": "14 days", "correct": false}, {"label": "D", "text": "16 days", "correct": false}], "correct_answer": "B. 8 days", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "At ovulation, what is released?", "options": [{"label": "A", "text": "Secondary oocyte at the end of meiosis I", "correct": true}, {"label": "B", "text": "Secondary oocyte at the end of meiosis II", "correct": false}, {"label": "C", "text": "Primary oocyte at the end of meiosis I", "correct": false}, {"label": "D", "text": "Primary oocyte at the end of meiosis II", "correct": false}], "correct_answer": "A. Secondary oocyte at the end of meiosis I", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Secondary &lt;span class=\"customMeta\" data-dictid=\"c6c40c102d1692777194a23b2674c4\"&gt;oocyte&lt;/span&gt; at the end of &lt;span class=\"customMeta\" data-dictid=\"5e3732fcf416927771923ad13f4d16\"&gt;meiosis&lt;/span&gt; I\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "The following instrument is used for the measurement of?", "options": [{"label": "A", "text": "Cooling power air", "correct": true}, {"label": "B", "text": "Radiant heat", "correct": false}, {"label": "C", "text": "Humidity", "correct": false}, {"label": "D", "text": "Temperature", "correct": false}], "correct_answer": "A. Cooling power air", "question_images": ["https://image.prepladder.com/content/HNCJXuebymHbEv5mlWV71724849842.png"], "explanation_images": ["https://image.prepladder.com/content/8jj1pYYEPLzZvnSNE7gr1724849943.png", "https://image.prepladder.com/content/2vZg7WlZ5Ro2naBpN2E51724849956.png"], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"579dcf5fc51692777185eef17a83c6\"&gt;Cooling&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Given 500 live births, 12 stillbirths, and 9 deaths within the first 7 days, calculate the Early Neonatal Mortality Rate (ENMR).", "options": [{"label": "A", "text": "18", "correct": true}, {"label": "B", "text": "36", "correct": false}, {"label": "C", "text": "24", "correct": false}, {"label": "D", "text": "50", "correct": false}], "correct_answer": "A. 18", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/hPrxR42XNGHlL9N50Zma1724761316.png", "https://image.prepladder.com/content/UYFC5wyPbC3iwtTbQ1G71724850579.png"], "explanation": "<p>Correct Option A\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A mother comes with her child who has papules on the extensor surfaces of the skin, which resolve with the administration of vitamins A and C and essential amino acids. What is your diagnosis?", "options": [{"label": "A", "text": "Phrynoderma", "correct": true}, {"label": "B", "text": "Rickets", "correct": false}, {"label": "C", "text": "Kwashiorkor", "correct": false}, {"label": "D", "text": "Marasmus", "correct": false}], "correct_answer": "A. Phrynoderma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Ph\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is the primary purpose of PEEP (Positive End-Expiratory Pressure) in mechanical ventilation?", "options": [{"label": "A", "text": "To increase respiratory rate", "correct": false}, {"label": "B", "text": "To reduce carbon dioxide levels", "correct": false}, {"label": "C", "text": "To increase the VR", "correct": false}, {"label": "D", "text": "To open alveoli and prevent atelectasis", "correct": true}], "correct_answer": "D. To open alveoli and prevent atelectasis", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/iGtRPWOMBTXMJSx5MnRg1724821936.png"], "explanation": "<p>Correct Option D – To open &lt;span class=\"customMeta\" data-dictid=\"0dd428c12116927771819285c8849c\"&gt;alveoli&lt;/span&gt; and prev\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A smoker presents with an oral lesion, as shown in the image below. Which stain is used to identify this pathology?", "options": [{"label": "A", "text": "Supravital stain", "correct": true}, {"label": "B", "text": "Congo red", "correct": false}, {"label": "C", "text": "Hematoxylin and eosin (H&amp;amp;E)", "correct": false}, {"label": "D", "text": "Oil red O", "correct": false}], "correct_answer": "A. Supravital stain", "question_images": ["https://image.prepladder.com/content/pI6fvSKPU4YNNH4MUMdS1724852571.png"], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"8677c6e8251692777199817455a36f\"&gt;Supravital&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Patient presents with features of right heart failure and exhibits a rapid Y descent on cardiac examination. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Constrictive pericarditis", "correct": true}, {"label": "B", "text": "Cardiac tamponade", "correct": false}, {"label": "C", "text": "Pulmonary hypertension", "correct": false}, {"label": "D", "text": "Right ventricular infarction", "correct": false}], "correct_answer": "A. Constrictive pericarditis", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"49386582661692777185faf9eaa8d8\"&gt;Constrictive&lt;/span&gt; P\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following antibodies is associated with celiac disease?", "options": [{"label": "A", "text": "Anti-TTG", "correct": true}, {"label": "B", "text": "ANCA", "correct": false}, {"label": "C", "text": "ASCA", "correct": false}, {"label": "D", "text": "AMA", "correct": false}], "correct_answer": "A. Anti-TTG", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Anti-TTG\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "In the given capnograph, what does the marked area denote?", "options": [{"label": "A", "text": "Expiratory upstroke", "correct": false}, {"label": "B", "text": "Alveolar Plateau", "correct": true}, {"label": "C", "text": "Inspiratory downstroke", "correct": false}, {"label": "D", "text": "Inspiratory baseline", "correct": false}], "correct_answer": "B. Alveolar Plateau", "question_images": ["https://image.prepladder.com/content/JmOCxo5EVFnVVbzwhtcZ1724932977.png"], "explanation_images": ["https://image.prepladder.com/content/cgbcNgd6tqyIzuPwJnQx1724836473.png"], "explanation": "<p>Correct Option B – Alveolar Plateau\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the device shown in the image?", "options": [{"label": "A", "text": "Nasopharyngeal airway", "correct": true}, {"label": "B", "text": "Laryngeal Mask Airway (LMA)", "correct": false}, {"label": "C", "text": "NG tube", "correct": false}, {"label": "D", "text": "Oropharyngeal tube", "correct": false}], "correct_answer": "A. Nasopharyngeal airway", "question_images": ["https://image.prepladder.com/content/nkHorIkD8cSNYQUew0KJ1724840492.png"], "explanation_images": ["https://image.prepladder.com/content/WxXbMinwPwJBzaIiZQE71724936728.PNG", "https://image.prepladder.com/content/SHgHC7zdHsS9vuPspdF71724936785.png", "https://image.prepladder.com/content/X2ZLKvQOoOkpo3bUYDDB1724936826.png"], "explanation": "<p>Correct Option A - Nasopharyng\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 45-year-old patient with a known case of homocystinuria presents with joint pain and weakness. Which vitamin is required for the treatment?", "options": [{"label": "A", "text": "Vitamin B6", "correct": true}, {"label": "B", "text": "Vitamin B12", "correct": false}, {"label": "C", "text": "Vitamin B1", "correct": false}, {"label": "D", "text": "Vitamin B7", "correct": false}], "correct_answer": "A. Vitamin B6", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Vitamin B6\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child presents with chorioretinitis, hydrocephalus, and cerebral calcifications. What is the most likely causative organism?", "options": [{"label": "A", "text": "Toxoplasma", "correct": true}, {"label": "B", "text": "CMV", "correct": false}, {"label": "C", "text": "Rubella", "correct": false}, {"label": "D", "text": "Zika", "correct": false}], "correct_answer": "A. Toxoplasma", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - T\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 3-year-old child presents with respiratory distress and a history of recurrent respiratory infections. Based on the radiographs provided, what is the most likely diagnosis?", "options": [{"label": "A", "text": "Lung abscess", "correct": false}, {"label": "B", "text": "Congenital pulmonary airway malformation", "correct": true}, {"label": "C", "text": "Pyopneumothorax", "correct": false}, {"label": "D", "text": "Congenital diaphragmatic hernia", "correct": false}], "correct_answer": "B. Congenital pulmonary airway malformation", "question_images": ["https://image.prepladder.com/content/oYZVptLUe438RHydQ6YF1724748907.png", "https://image.prepladder.com/content/fzUhbAdEuUtw79IVHQBB1724748911.png", "https://image.prepladder.com/content/DC2diBInwzEFe7ruliPW1724748914.png"], "explanation_images": ["https://image.prepladder.com/content/T0QnqJJh796nVY6VT3AY1724749280.png", "https://image.prepladder.com/content/IIL3DIjuyRqaN7tMq8nk1724749294.png"], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"488a4efe7d16927771840c9e29f164\"&gt;Congenital&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"10e2dee19e1692777196673db90c23\"&gt;pulmonary&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"3b9dd3166f1692777180b697887ccb\"&gt;airway&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Sequence of rigor mortis is?", "options": [{"label": "A", "text": "Center to periphery", "correct": false}, {"label": "B", "text": "Head to foot", "correct": true}, {"label": "C", "text": "Foot to head", "correct": false}, {"label": "D", "text": "Simultaneously", "correct": false}], "correct_answer": "B. Head to foot", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - H\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young patient presents to the outpatient department (OPD) with recurrent colicky abdominal pain. Urine examination reveals the presence of red blood cells (RBCs). What is the most likely diagnosis?", "options": [{"label": "A", "text": "Glomerulonephritis", "correct": false}, {"label": "B", "text": "Oxalate stone", "correct": false}, {"label": "C", "text": "Polycystic kidney disease", "correct": false}, {"label": "D", "text": "Cystine stone", "correct": true}], "correct_answer": "D. Cystine stone", "question_images": ["https://image.prepladder.com/content/TrGRGyzxXdiLXWYoxTKa1724851089.png"], "explanation_images": [], "explanation": "<p>Correct Option D - &lt;span class=\"customMeta\" data-dictid=\"c65131cb591692777185e8b4d0055f\"&gt;Cystine&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the syndrome associated with the chromosomal pattern shown in the image below:", "options": [{"label": "A", "text": "Angelman syndrome", "correct": false}, {"label": "B", "text": "Prader-Willi syndrome", "correct": true}, {"label": "C", "text": "Rett syndrome", "correct": false}, {"label": "D", "text": "Cri-du-chat syndrome", "correct": false}], "correct_answer": "B. Prader-Willi syndrome", "question_images": ["https://image.prepladder.com/content/SlWxjZTCKKbiAxzoEY0K1724833325.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/ETvv2IqxR5DPLSvY97gZ1748420571.mp3", "video": ""}, {"text": "Identify the image given?", "options": [{"label": "A", "text": "Arohi from HIV", "correct": false}, {"label": "B", "text": "Sapna Leprosy", "correct": true}, {"label": "C", "text": "Meena Unicef", "correct": false}, {"label": "D", "text": "None of the above", "correct": false}], "correct_answer": "B. Sapna Leprosy", "question_images": ["https://image.prepladder.com/content/6Is32rHBzltiE5WJWnTT1724850660.png"], "explanation_images": ["https://image.prepladder.com/content/FCoz0rpYiQ0VX6l4CWJ61724850812.png", "https://image.prepladder.com/content/TIZakscBeHwj1AtHcz8o1724850928.png"], "explanation": "<p>Correct Option B - Sapna L\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the gene commonly involved in the carcinoma shown in the image below:", "options": [{"label": "A", "text": "RAS", "correct": false}, {"label": "B", "text": "RET", "correct": false}, {"label": "C", "text": "BRAF V600", "correct": true}, {"label": "D", "text": "P53", "correct": false}], "correct_answer": "C. BRAF V600", "question_images": ["https://image.prepladder.com/content/pZsT6MVPe1J5vA2rxZZp1724849727.png"], "explanation_images": [], "explanation": "<p>Correct Option C - BRAF V6\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A mother brings her 14-year-old mentally retarded son to the clinic, complaining of joint pain and an irresistible urge for the boy to bite his fingers and lips. Serum uric acid is elevated. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Lesch-Nyhan syndrome", "correct": true}, {"label": "B", "text": "Gout", "correct": false}, {"label": "C", "text": "Hyperuricemia", "correct": false}, {"label": "D", "text": "Juvenile arthritis", "correct": false}], "correct_answer": "A. Lesch-Nyhan syndrome", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Lesch-Nyh\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A female patient with a urinary tract infection (UTI) has more than 10^4 colonies of novobiocin-resistant Staphylococcus. What is the appropriate course of action?", "options": [{"label": "A", "text": "Consider UTI", "correct": true}, {"label": "B", "text": "Take three urine samples", "correct": false}, {"label": "C", "text": "No treatment is needed", "correct": false}, {"label": "D", "text": "Contaminated sample", "correct": false}], "correct_answer": "A. Consider UTI", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/MOD216bGeGE7bE8289Aa1724837346.png"], "explanation": "<p>Correct Option A - Consider UTI\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child presents with failure to pass stools and is diagnosed with Hirschsprung disease. Which among the following layers of the colon will show congenital absence of neurons?", "options": [{"label": "A", "text": "1 &amp;amp; 2", "correct": false}, {"label": "B", "text": "2 &amp;amp; 3", "correct": true}, {"label": "C", "text": "3 &amp;amp; 4", "correct": false}, {"label": "D", "text": "1 &amp;amp; 4", "correct": false}], "correct_answer": "B. 2 &amp; 3", "question_images": ["https://image.prepladder.com/content/57oMD5hdOlteVgNrd6hF1724915066.png"], "explanation_images": [], "explanation": "<p>Correct Option B - 2 &amp;amp; 3\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Identify the visual field defect:", "options": [{"label": "A", "text": "Altitudinal defect", "correct": false}, {"label": "B", "text": "Roennes nasal step", "correct": false}, {"label": "C", "text": "Blind spot enlargement", "correct": true}, {"label": "D", "text": "Arcuate scotoma", "correct": false}], "correct_answer": "C. Blind spot enlargement", "question_images": ["https://image.prepladder.com/content/RwCVQUk05g2L1W0ixkHJ1724828138.png"], "explanation_images": ["https://image.prepladder.com/content/ydOBTBDoBF5Oo3msoQY31724828359.png", "https://image.prepladder.com/content/fsCEKlTiYHBdHGIruQEv1724828376.png", "https://image.prepladder.com/content/UpoPh6SX6CgVsIs4wgS11724828401.png", "https://image.prepladder.com/content/BDj76ykCj93eiBN4KR0H1724828423.png"], "explanation": "<p>Correct Option C - Blind spot enlarg\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following is not a contraindication for External Cephalic Version (ECV)?", "options": [{"label": "A", "text": "Placenta previa", "correct": false}, {"label": "B", "text": "Twin pregnancy", "correct": false}, {"label": "C", "text": "Primigravida", "correct": true}, {"label": "D", "text": "PROM (Premature Rupture of Membranes)", "correct": false}], "correct_answer": "C. Primigravida", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C – Primigrav\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with hypotension, hyponatremia and blackening of the knuckles and perioral area. Which of the following conditions is most likely associated with these symptoms?", "options": [{"label": "A", "text": "Conn syndrome", "correct": false}, {"label": "B", "text": "Cushing's syndrome", "correct": false}, {"label": "C", "text": "Primary ACTH deficiency", "correct": false}, {"label": "D", "text": "Addison’s disease", "correct": true}], "correct_answer": "D. Addison’s disease", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option D - Addison’s D\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Symptoms</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Hypotension, hyponatremia, <span class=\"customMeta\" data-dictid=\"30261213bf16927771898b5d2f245d\">hyperpigmentation</span> (knuckles, perioral)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Cause</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Primary <span class=\"customMeta\" data-dictid=\"f955f012f716927771801d01e7d163\">adrenal</span> <span class=\"customMeta\" data-dictid=\"80feaae4b31692777190ea1ba3fc25\">insufficiency</span> (low <span class=\"customMeta\" data-dictid=\"1698cefc83169277718522e3f5fd61\">cortisol</span> and aldosterone)</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Pathophysiology</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Elevated <span class=\"customMeta\" data-dictid=\"55fd11666f1692777180e80135bda8\">ACTH</span> due to low <span class=\"customMeta\" data-dictid=\"1698cefc83169277718522e3f5fd61\">cortisol</span> levels leads to increased <span class=\"customMeta\" data-dictid=\"afe514c80616927771928d403a54fa\">melanin</span> production</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Lab Findings</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Low sodium, high potassium, low cortisol, high ACTH</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Management</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Corticosteroid replacement therapy (hydrocortisone, fludrocortisone)</p>\n</td>\n</tr>\n</tbody>\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 25-year-old patient presents with rashes with an orange hue on his body and thickened palms and soles. Based on the histological image given, what is the diagnosis?", "options": [{"label": "A", "text": "Pityriasis rubra pilaris", "correct": true}, {"label": "B", "text": "Keratosis follicularis", "correct": false}, {"label": "C", "text": "Follicular psoriasis", "correct": false}, {"label": "D", "text": "Cutaneous T-cell lymphoma", "correct": false}], "correct_answer": "A. Pityriasis rubra pilaris", "question_images": ["https://image.prepladder.com/content/K1VPMUNf22z5vv5mVmYu1724753226.png", "https://image.prepladder.com/content/tQcNIiJqR4NuE4l4GJh31724753226.png"], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"2918c7cf5716927771956553e7f2f3\"&gt;Pityriasis&lt;/span&gt; ru\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents to the outpatient department with the following findings. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Pterygium", "correct": false}, {"label": "B", "text": "Limbal dermoid", "correct": true}, {"label": "C", "text": "Pyogenic granuloma", "correct": false}, {"label": "D", "text": "Pinguecula", "correct": false}], "correct_answer": "B. Limbal dermoid", "question_images": ["https://image.prepladder.com/content/HpFBtLMd2PHTWKsqsO7B1724832934.png"], "explanation_images": [], "explanation": "<p>Correct Option B - &lt;span class=\"customMeta\" data-dictid=\"71928251b41692777191a31e57c47f\"&gt;Limbal&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 34-year-old female presents with low hemoglobin, platelet count of 25,000/mm 3 , and raised PT and APTT. The peripheral smear image is shown below. Which of the following fusion genes is likely affected?", "options": [{"label": "A", "text": "PML-RARA", "correct": true}, {"label": "B", "text": "RUNX1-RUNX1T1", "correct": false}, {"label": "C", "text": "INV 16", "correct": false}, {"label": "D", "text": "IGH-NSD2", "correct": false}], "correct_answer": "A. PML-RARA", "question_images": ["https://image.prepladder.com/content/KmunspEZH2rteJFq72GS1724849639.png"], "explanation_images": [], "explanation": "<p>Correct Option A - PML-RARA\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A child presents with leukocoria and an intraocular mass. Microscopic examination reveals rosettes with scanty cytoplasm, and the mass is positive for synaptophysin and chromogranin. What is the diagnosis?", "options": [{"label": "A", "text": "Retinoblastoma", "correct": true}, {"label": "B", "text": "Medulloblastoma", "correct": false}, {"label": "C", "text": "Optic glioma", "correct": false}, {"label": "D", "text": "Choroidal melanoma", "correct": false}], "correct_answer": "A. Retinoblastoma", "question_images": [], "explanation_images": ["https://image.prepladder.com/content/oBRXTKSEJ3pBtfFY1L7d1724831165.png"], "explanation": "<p>Correct Option A – R\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A pregnant woman has just delivered a healthy baby via normal delivery. What is the earliest time at which an intrauterine contraceptive device (IUCD) can be inserted?", "options": [{"label": "A", "text": "Within 48 hours", "correct": true}, {"label": "B", "text": "After 6 weeks", "correct": false}, {"label": "C", "text": "After 3 months", "correct": false}, {"label": "D", "text": "After 6 months", "correct": false}], "correct_answer": "A. Within 48 hours", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A 38-year-old patient presents with chest pain and hoarseness of voice for the past month. Based on the radiographic image provided, what is the most likely diagnosis?", "options": [{"label": "A", "text": "Saccular aneurysm of the distal arch", "correct": true}, {"label": "B", "text": "Dissecting aneurysm of the arch of the aorta", "correct": false}, {"label": "C", "text": "Coarctation of the aorta", "correct": false}, {"label": "D", "text": "Stenosis of the aorta", "correct": false}], "correct_answer": "A. Saccular aneurysm of the distal arch", "question_images": ["https://image.prepladder.com/content/ur4UeELho78zNNYQIyeb1724744037.png"], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"df4e8e3ae81692777198a0513bc88c\"&gt;Saccular&lt;/span&gt; &lt;span class=\"customMeta\" data-dictid=\"f2c92eaffe16927771819978aa5666\"&gt;aneurysm&lt;/span&gt; of the &lt;span class=\"customMeta\" data-dictid=\"5ff25303a01692777186731f6a4f5c\"&gt;distal&lt;/span&gt; arch\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Patient presents with recurrent lung infections and CXR is given below. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Kartagener syndrome", "correct": true}, {"label": "B", "text": "Cystic fibrosis", "correct": false}, {"label": "C", "text": "Digeorge syndrome", "correct": false}, {"label": "D", "text": "Down syndrome", "correct": false}], "correct_answer": "A. Kartagener syndrome", "question_images": ["https://image.prepladder.com/content/fQTrJp8ZwP6p07KLcRgi1724847486.png"], "explanation_images": [], "explanation": "<p>Correct Option A - Kartag\n<table cellspacing=\"0\" style=\"border-collapse:collapse\">\n<tbody>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p><strong>Condition</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; vertical-align:top\">\n<p>Kartagener syndrome</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Key Features</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Dextrocardia (situs inversus), chronic sinusitis, bronchiectasis</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Diagnosis</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Confirmed by CXR showing <span class=\"customMeta\" data-dictid=\"dad4b8efe11692777186757f861421\">dextrocardia</span> and clinical symptoms</p>\n</td>\n</tr>\n<tr>\n<td style=\"border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p><strong>Distinguishing Factors</strong></p>\n</td>\n<td style=\"border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top\">\n<p>Presence of <span class=\"customMeta\" data-dictid=\"35a2ef94341692777198d9bf1cd98e\">situs</span> <span class=\"customMeta\" data-dictid=\"db022f35d816927771903c9a398884\">inversus</span> and <span class=\"customMeta\" data-dictid=\"c64e3a661b1692777197afc2ff7bca\">recurrent</span> lung infections</p>\n</td>\n</tr>\n</tbody>\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A mother brings her daughter to the emergency room, reporting that she ingested an unknown substance. She presents with hypertension, tachycardia, hyperthermia, and mydriasis. Which of the following substances is most likely responsible for these symptoms?", "options": [{"label": "A", "text": "Heroin", "correct": false}, {"label": "B", "text": "Morphine", "correct": false}, {"label": "C", "text": "Cocaine", "correct": true}, {"label": "D", "text": "Chlorpheniramine", "correct": false}], "correct_answer": "C. Cocaine", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option C – C\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "What is Celiac Sprue in a child?", "options": [{"label": "A", "text": "Anti-tissue transglutaminase (tTG) antibodies are positive and used as a screening test", "correct": true}, {"label": "B", "text": "A type of food allergy causing skin rashes", "correct": false}, {"label": "C", "text": "A genetic disorder leading to lactose intolerance", "correct": false}, {"label": "D", "text": "An infection in the gastrointestinal tract caused by bacteria", "correct": false}], "correct_answer": "A. Anti-tissue transglutaminase (tTG) antibodies are positive and used as a screening test", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - Anti-tissue &lt;span class=\"customMeta\" data-dictid=\"4a47b71b801692777200d06df00a08\"&gt;transglutaminase&lt;/span&gt; (tTG) antibodies are positive and used as a screening\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "https://image.prepladder.com/content/lFEkPykDpi1Or5UJV6Sx1744570948.mp3", "video": ""}, {"text": "A 65-year-old chronic alcoholic who began binge drinking ten days ago is brought to the emergency department in an unconscious state. A CT scan of his brain is normal, but his blood glucose level is 45 mg/dL. What is the most appropriate initial management?", "options": [{"label": "A", "text": "Normal saline hydration", "correct": false}, {"label": "B", "text": "IM Thiamine followed by dextrose", "correct": true}, {"label": "C", "text": "Dextrose 25%", "correct": false}, {"label": "D", "text": "Vitamin K with 5% dextrose", "correct": false}], "correct_answer": "B. IM Thiamine followed by dextrose", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - IM &lt;span class=\"customMeta\" data-dictid=\"b70d1dbde516927772000d7774d2a5\"&gt;Thiamine&lt;/span&g\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "At what age is surgery typically performed for cleft lip?", "options": [{"label": "A", "text": "3 months", "correct": true}, {"label": "B", "text": "6 months", "correct": false}, {"label": "C", "text": "1 year", "correct": false}, {"label": "D", "text": "18 months", "correct": false}], "correct_answer": "A. 3 months", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which of the following statements is false regarding the condition shown in the image?", "options": [{"label": "A", "text": "NOSPEC classification is used", "correct": false}, {"label": "B", "text": "Management corresponds to an improvement in the thyrotoxic state", "correct": true}, {"label": "C", "text": "Vision loss may occur", "correct": false}, {"label": "D", "text": "It is not seen in 10% of patients with hyperthyroidism", "correct": false}], "correct_answer": "B. Management corresponds to an improvement in the thyrotoxic state", "question_images": ["https://image.prepladder.com/content/03gzCNvcZlpUXDpSFMZw1724830659.png"], "explanation_images": [], "explanation": "<p>Correct Option B - Management corresponds to an improvement in the &lt;span class=\"customMeta\" data-dictid=\"d1ad396c00169277720080f8a84f23\"&gt;thyrotoxic&lt;/span&g\n\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Which drug acts on the rounded up enzyme?", "options": [{"label": "A", "text": "Aminocapric acid", "correct": true}, {"label": "B", "text": "Tenecteplase", "correct": false}, {"label": "C", "text": "Streptokinase", "correct": false}, {"label": "D", "text": "Apixaban", "correct": false}], "correct_answer": "A. Aminocapric acid", "question_images": ["https://image.prepladder.com/content/49xiCCgCoewjq8hfNZb11724836291.png"], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A young woman presents with weight loss, tachycardia, heat intolerance, and tremors. On examination, she has exophthalmos. What is the most likely diagnosis?", "options": [{"label": "A", "text": "Parkinson's disease", "correct": false}, {"label": "B", "text": "Graves' disease", "correct": true}, {"label": "C", "text": "Addison's disease", "correct": false}, {"label": "D", "text": "Alzheimer's disease", "correct": false}], "correct_answer": "B. Graves' disease", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Grav\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Tubectomy is typically performed at which part of the fallopian tube, and why?", "options": [{"label": "A", "text": "Ampulla - Uniform thickness of muscle", "correct": false}, {"label": "B", "text": "Ampulla - Widest part", "correct": false}, {"label": "C", "text": "Ampulla-Isthmus Junction - Site of fertilization", "correct": false}, {"label": "D", "text": "Isthmus - Narrowest part", "correct": true}], "correct_answer": "D. Isthmus - Narrowest part", "question_images": [], "explanation_images": [], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient is experiencing phantom limb pain after amputation of right limb .What is observed on a PET scan in a patient with phantom limb pain?", "options": [{"label": "A", "text": "Expansion of right somatosensory fibers for the hand into neighboring areas", "correct": false}, {"label": "B", "text": "Neighboring fibers of the right somatosensory area extending into the right-hand area", "correct": true}, {"label": "C", "text": "Expansion of right sensory cortex", "correct": false}, {"label": "D", "text": "Expansion of Left sensory cortex", "correct": false}], "correct_answer": "B. Neighboring fibers of the right somatosensory area extending into the right-hand area", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option B - Neighboring fibers of the right &lt;span class=\"customMeta\" data-dictid=\"be46da176016927771984a269a5b2c\"&gt;somatosensory&lt;/span&gt; area extending into the right-h\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "Match the following: 1 Greater auricular nerve 2 Auriculotemporal nerve 3 Auricular branch of the vagus nerve 4 Lesser occipital nerve", "options": [{"label": "A", "text": "1-D, 2-C, 3-A, 4-B", "correct": false}, {"label": "B", "text": "1-C, 2-A, 3-B, 4-D", "correct": true}, {"label": "C", "text": "1-C, 2-B, 3-A, 4-D", "correct": false}, {"label": "D", "text": "1-D, 2-A, 3-B, 4-C", "correct": false}], "correct_answer": "B. 1-C, 2-A, 3-B, 4-D", "question_images": ["https://image.prepladder.com/content/qAy7WFuikz9RPNTNlVqy1724847173.png"], "explanation_images": ["https://image.prepladder.com/content/3kWhXSobVjidhRNRwoQa1724847266.png"], "explanation": "\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A patient presents with a cerebellar mass and a renal tumor, along with a similar family history. Which of the following is responsible for his findings?", "options": [{"label": "A", "text": "VHL", "correct": true}, {"label": "B", "text": "NF", "correct": false}, {"label": "C", "text": "TSC", "correct": false}, {"label": "D", "text": "Li Fraumeni syndrome", "correct": false}], "correct_answer": "A. VHL", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A – VHL\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}, {"text": "A man wears a female dress and high heels and gets pleasure by doing so. He was not attracted to the same gender. This condition is?", "options": [{"label": "A", "text": "Transvestic fetishism", "correct": true}, {"label": "B", "text": "Voyeurism", "correct": false}, {"label": "C", "text": "Sexual dysphoria", "correct": false}, {"label": "D", "text": "Gay orientation", "correct": false}], "correct_answer": "A. Transvestic fetishism", "question_images": [], "explanation_images": [], "explanation": "<p>Correct Option A - &lt;span class=\"customMeta\" data-dictid=\"5f6a6bae2a1692777200a3a754073a\"&gt;Transvestic&lt;/span&gt; fetish\n\n<p style='font-size: 10px; color: #808080; font-style: italic;'>@dams_new_robot</p>", "bot": "@dams_new_robot", "audio": "", "video": ""}]; if (!Array.isArray(questions) || questions.length === 0) { throw new Error("Questions data is empty or invalid"); } debugLog(`Successfully parsed ${questions.length} questions`); } catch (e) { console.error("Failed to parse questions_json:", e); document.getElementById('error-message').innerHTML = "Error loading quiz data. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; // Fallback to sample questions for testing questions = [ { text: "What is 2 + 2?", options: [ { label: "A", text: "3", correct: false }, { label: "B", text: "4", correct: true }, { label: "C", text: "5", correct: false }, { label: "D", text: "6", correct: false } ], correct_answer: "B. 4", question_images: [], explanation_images: [], explanation: "<p>2 + 2 = 4</p><p>@dams_new_robot</p>", bot: "@dams_new_robot", audio: "", video: "" } ]; debugLog("Loaded fallback questions"); } // Quiz state let currentQuestion = 0; let answers = new Array(questions.length).fill(null); let markedForReview = new Array(questions.length).fill(false); let timeRemaining = 210 * 60; // Duration in seconds let timerInterval = null; const quizId = `{title.replace(/\s+/g, '_').toLowerCase()}`; // Unique ID for local storage // Load saved progress function loadProgress() { try { debugLog("Loading progress from localStorage"); const saved = localStorage.getItem(`quiz_${quizId}`); if (saved) { const { savedAnswers, savedMarked, savedTime } = JSON.parse(saved); answers = savedAnswers || answers; markedForReview = savedMarked || markedForReview; timeRemaining = savedTime !== undefined ? savedTime : timeRemaining; debugLog("Progress loaded successfully"); } else { debugLog("No saved progress found"); } } catch (e) { console.error("Error loading progress:", e); debugLog("Failed to load progress: " + e.message); } } // Save progress function saveProgress() { try { debugLog("Saving progress to localStorage"); localStorage.setItem(`quiz_${quizId}`, JSON.stringify({ savedAnswers: answers, savedMarked: markedForReview, savedTime: timeRemaining })); debugLog("Progress saved successfully"); } catch (e) { console.error("Error saving progress:", e); debugLog("Failed to save progress: " + e.message); } } // Initialize quiz function initQuiz() { try { debugLog("Initializing quiz"); loadProgress(); const startButton = document.getElementById('start-test'); if (!startButton) { throw new Error("Start test button not found"); } startButton.addEventListener('click', startQuiz); debugLog("Start test button listener attached"); document.getElementById('previous-btn').addEventListener('click', showPreviousQuestion); document.getElementById('next-btn').addEventListener('click', showNextQuestion); document.getElementById('mark-review').addEventListener('click', toggleMarkForReview); document.getElementById('nav-toggle').addEventListener('click', toggleNavPanel); document.getElementById('submit-test').addEventListener('click', showSubmitModal); document.getElementById('continue-test').addEventListener('click', closeExitModal); document.getElementById('exit-test').addEventListener('click', () => { debugLog("Exiting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('cancel-submit').addEventListener('click', closeSubmitModal); document.getElementById('confirm-submit').addEventListener('click', submitTest); document.getElementById('take-again').addEventListener('click', () => { debugLog("Restarting test"); localStorage.removeItem(`quiz_${quizId}`); window.location.reload(); }); document.getElementById('review-test').addEventListener('click', () => showResults(currentResultQuestion)); document.getElementById('close-nav').addEventListener('click', toggleNavPanel); document.getElementById('theme-toggle').addEventListener('click', toggleTheme); document.getElementById('nav-filter').addEventListener('change', updateNavPanel); document.getElementById('prev-result').addEventListener('click', showPreviousResult); document.getElementById('next-result').addEventListener('click', showNextResult); document.getElementById('results-nav-toggle').addEventListener('click', toggleResultsNavPanel); document.getElementById('close-results-nav').addEventListener('click', toggleResultsNavPanel); document.getElementById('results-nav-filter').addEventListener('change', updateResultsNavPanel); debugLog("Quiz initialized successfully"); } catch (e) { console.error("Failed to initialize quiz:", e); debugLog("Failed to initialize quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('start-test').disabled = true; } } // Start quiz function startQuiz() { try { debugLog("Starting quiz"); document.getElementById('instructions').classList.add('hidden'); document.getElementById('quiz').classList.remove('hidden'); showQuestion(currentQuestion); startTimer(); updateNavPanel(); debugLog("Quiz started successfully"); } catch (e) { console.error("Error starting quiz:", e); debugLog("Failed to start quiz: " + e.message); document.getElementById('error-message').innerHTML = "Error starting quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); document.getElementById('quiz').classList.add('hidden'); document.getElementById('instructions').classList.remove('hidden'); } } // Show question function showQuestion(index) { try { debugLog(`Showing question ${index + 1}`); currentQuestion = index; const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } document.getElementById('question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('question-text').innerHTML = q.text || "No question text available"; const imagesDiv = document.getElementById('question-images'); imagesDiv.innerHTML = q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg">`).join('') : ''; const optionsDiv = document.getElementById('options'); optionsDiv.innerHTML = q.options && q.options.length > 0 ? q.options.map(opt => ` <button class="option-btn w-full text-left p-3 border rounded-lg ${answers[index] === opt.label ? 'selected' : ''}" onclick="selectOption(${index}, '${opt.label}')" aria-label="Option ${opt.label}: ${opt.text}"> ${opt.label}. ${opt.text} </button> `).join('') : '<p class="text-red-500">No options available</p>'; document.getElementById('previous-btn').disabled = index === 0; document.getElementById('next-btn').disabled = index === questions.length - 1; document.getElementById('mark-review').classList.toggle('marked', markedForReview[index]); updateProgressBar(); saveProgress(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying question:", e); debugLog("Failed to display question: " + e.message); } } // Select option function selectOption(index, label) { try { debugLog(`Selecting option ${label} for question ${index + 1}`); answers[index] = label; const optionsDiv = document.getElementById('options'); const optionButtons = optionsDiv.querySelectorAll('.option-btn'); optionButtons.forEach(btn => { const btnLabel = btn.textContent.trim().split('.')[0]; btn.classList.toggle('selected', btnLabel === label); }); updateNavPanel(); saveProgress(); debugLog(`Option ${label} selected for question ${index + 1}`); } catch (e) { console.error("Error selecting option:", e); debugLog("Failed to select option: " + e.message); } } // Toggle mark for review function toggleMarkForReview() { try { debugLog(`Toggling mark for review on question ${currentQuestion + 1}`); markedForReview[currentQuestion] = !markedForReview[currentQuestion]; document.getElementById('mark-review').classList.toggle('marked', markedForReview[currentQuestion]); updateNavPanel(); saveProgress(); debugLog(`Mark for review toggled for question ${currentQuestion + 1}`); } catch (e) { console.error("Error marking for review:", e); debugLog("Failed to mark for review: " + e.message); } } // Navigate to previous question function showPreviousQuestion() { try { debugLog(`Navigating to previous question from ${currentQuestion + 1}`); if (currentQuestion > 0) { currentQuestion--; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to previous question:", e); debugLog("Failed to navigate to previous question: " + e.message); } } // Navigate to next question function showNextQuestion() { try { debugLog(`Navigating to next question from ${currentQuestion + 1}`); if (currentQuestion < questions.length - 1) { currentQuestion++; showQuestion(currentQuestion); } } catch (e) { console.error("Error navigating to next question:", e); debugLog("Failed to navigate to next question: " + e.message); } } // Handle question navigation click function handleQuestionNavClick(index) { try { debugLog(`Navigating to question ${index + 1} via nav panel`); showQuestion(index); toggleNavPanel(); } catch (e) { console.error("Error handling navigation click:", e); debugLog("Failed to navigate via nav panel: " + e.message); } } // Start timer function startTimer() { try { debugLog("Starting timer"); timerInterval = setInterval(() => { if (timeRemaining <= 0) { debugLog("Timer expired, submitting test"); clearInterval(timerInterval); submitTest(); } else { timeRemaining--; const minutes = Math.floor(timeRemaining / 60); const seconds = timeRemaining % 60; document.getElementById('timer').innerHTML = `Time Remaining: <span>${minutes.toString().padStart(2, '0')}:${seconds.toString().padStart(2, '0')}</span>`; saveProgress(); } }, 1000); debugLog("Timer started successfully"); } catch (e) { console.error("Error starting timer:", e); debugLog("Failed to start timer: " + e.message); } } // Update progress bar function updateProgressBar() { try { debugLog("Updating progress bar"); const progress = ((currentQuestion + 1) / questions.length) * 100; document.getElementById('progress-bar').style.width = `${progress}%`; debugLog("Progress bar updated"); } catch (e) { console.error("Error updating progress bar:", e); debugLog("Failed to update progress bar: " + e.message); } } // Update quiz navigation panel function updateNavPanel() { try { debugLog("Updating quiz navigation panel"); const filter = document.getElementById('nav-filter').value; const navGrid = document.getElementById('nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="question-nav-btn ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleQuestionNavClick(${i})" aria-label="Go to Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Quiz navigation panel updated"); } catch (e) { console.error("Error updating quiz navigation panel:", e); debugLog("Failed to update quiz navigation panel: " + e.message); } } // Update results navigation panel function updateResultsNavPanel() { try { debugLog("Updating results navigation panel"); const filter = document.getElementById('results-nav-filter').value; const navGrid = document.getElementById('results-nav-grid'); navGrid.innerHTML = questions.map((_, i) => { if (filter === 'answered' && !answers[i]) return ''; if (filter === 'unanswered' && answers[i]) return ''; if (filter === 'marked' && !markedForReview[i]) return ''; return ` <button class="result-nav-btn-grid ${answers[i] ? 'answered' : 'unanswered'} ${markedForReview[i] ? 'marked-nav' : ''}" onclick="handleResultNavClick(${i})" aria-label="Go to Result for Question ${i + 1}"> ${i + 1} </button> `; }).join(''); debugLog("Results navigation panel updated"); } catch (e) { console.error("Error updating results navigation panel:", e); debugLog("Failed to update results navigation panel: " + e.message); } } // Toggle quiz navigation panel function toggleNavPanel() { try { debugLog("Toggling quiz navigation panel"); const navPanel = document.getElementById('nav-panel'); navPanel.classList.toggle('hidden'); debugLog("Quiz navigation panel toggled"); } catch (e) { console.error("Error toggling quiz navigation panel:", e); debugLog("Failed to toggle quiz navigation panel: " + e.message); } } // Toggle results navigation panel function toggleResultsNavPanel() { try { debugLog("Toggling results navigation panel"); const resultsNavPanel = document.getElementById('results-nav-panel'); resultsNavPanel.classList.toggle('hidden'); if (!resultsNavPanel.classList.contains('hidden')) { updateResultsNavPanel(); } debugLog("Results navigation panel toggled"); } catch (e) { console.error("Error toggling results navigation panel:", e); debugLog("Failed to toggle results navigation panel: " + e.message); } } // Handle result navigation click function handleResultNavClick(index) { try { debugLog(`Navigating to result for question ${index + 1} via nav panel`); showResults(index); toggleResultsNavPanel(); } catch (e) { console.error("Error handling result navigation click:", e); debugLog("Failed to navigate to result: " + e.message); } } // Show submit modal function showSubmitModal() { try { debugLog("Showing submit modal"); const attempted = answers.filter(a => a !== null).length; document.getElementById('attempted-count').textContent = attempted; document.getElementById('unattempted-count').textContent = questions.length - attempted; document.getElementById('submit-modal').classList.remove('hidden'); debugLog("Submit modal displayed"); } catch (e) { console.error("Error showing submit modal:", e); debugLog("Failed to show submit modal: " + e.message); } } // Close submit modal function closeSubmitModal() { try { debugLog("Closing submit modal"); document.getElementById('submit-modal').classList.add('hidden'); debugLog("Submit modal closed"); } catch (e) { console.error("Error closing submit modal:", e); debugLog("Failed to close submit modal: " + e.message); } } // Close exit modal function closeExitModal() { try { debugLog("Closing exit modal"); document.getElementById('exit-modal').classList.add('hidden'); debugLog("Exit modal closed"); } catch (e) { console.error("Error closing exit modal:", e); debugLog("Failed to close exit modal: " + e.message); } } // Submit test function submitTest() { try { debugLog("Submitting test"); clearInterval(timerInterval); document.getElementById('quiz').classList.add('hidden'); document.getElementById('submit-modal').classList.add('hidden'); document.getElementById('results').classList.remove('hidden'); showResults(0); // Start with first question // Trigger confetti animation confetti({ particleCount: 100, spread: 70, origin: { y: 0.6 } }); localStorage.removeItem(`quiz_${quizId}`); debugLog("Test submitted successfully"); } catch (e) { console.error("Error submitting test:", e); debugLog("Failed to submit test: " + e.message); } } // Show result for a single question function showResults(index) { try { debugLog(`Showing result for question ${index + 1}`); currentResultQuestion = index; let correct = 0, wrong = 0, unanswered = 0, marked = 0; answers.forEach((answer, i) => { const isCorrect = answer && questions[i].options.find(opt => opt.label === answer)?.correct; if (answer === null) unanswered++; else if (isCorrect) correct++; else wrong++; if (markedForReview[i]) marked++; }); const q = questions[index]; if (!q) { throw new Error(`Question ${index} is undefined`); } const userAnswer = answers[index]; const isCorrect = userAnswer && q.options.find(opt => opt.label === userAnswer)?.correct; const resultsContent = document.getElementById('results-content'); resultsContent.innerHTML = ` <div class="border p-4 rounded-lg ${isCorrect ? 'bg-green-50' : userAnswer ? 'bg-red-50' : 'bg-gray-50'}"> <p class="font-semibold">Question ${index + 1}: ${q.text || 'No question text'}</p> ${q.question_images && q.question_images.length > 0 ? q.question_images.map(url => `<img src="${url}" alt="Question Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} <p><strong>Your Answer:</strong> ${userAnswer ? `${userAnswer}. ${q.options.find(opt => opt.label === userAnswer)?.text || 'Invalid option'}` : 'Unanswered'}</p> <p><strong>Correct Answer:</strong> ${q.correct_answer || 'Unknown'}</p> <div class="mt-2">${q.explanation || 'No explanation available'}</div> ${q.explanation_images && q.explanation_images.length > 0 ? q.explanation_images.map(url => `<img src="${url}" alt="Explanation Image" class="max-w-full h-auto rounded-lg my-2">`).join('') : ''} ${q.video ? ` <button class="play-video bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadVideo(this, '${q.video}', 'video-${index}')" aria-label="Play explanation video for Question ${index + 1}"> Play Video Explanation </button> <div id="video-${index}" class="video-container mt-2"></div> ` : '<p class="text-gray-500 mt-2">No video available</p>'} ${q.audio ? ` <button class="play-audio bg-blue-500 text-white px-4 py-2 rounded-lg mt-2" onclick="loadAudio(this, '${q.audio}', 'audio-${index}')" aria-label="Play audio explanation for Question ${index + 1}"> Play Audio Explanation </button> <div id="audio-${index}" class="audio-container mt-2"></div> ` : ''} </div> `; document.getElementById('correct-count').textContent = correct; document.getElementById('wrong-count').textContent = wrong; document.getElementById('unanswered-count').textContent = unanswered; document.getElementById('marked-count').textContent = marked; document.getElementById('result-question-number').innerHTML = `Question <span>${index + 1}</span> of ${questions.length}`; document.getElementById('prev-result').disabled = index === 0; document.getElementById('next-result').disabled = index === questions.length - 1; updateResultsNavPanel(); window.scrollTo({ top: 0, behavior: 'smooth' }); debugLog(`Result for question ${index + 1} displayed successfully`); } catch (e) { console.error("Error displaying result:", e); debugLog("Failed to display result: " + e.message); } } // Navigate to previous result function showPreviousResult() { try { debugLog(`Navigating to previous result from question ${currentResultQuestion + 1}`); if (currentResultQuestion > 0) { showResults(currentResultQuestion - 1); } } catch (e) { console.error("Error navigating to previous result:", e); debugLog("Failed to navigate to previous result: " + e.message); } } // Navigate to next result function showNextResult() { try { debugLog(`Navigating to next result from question ${currentResultQuestion + 1}`); if (currentResultQuestion < questions.length - 1) { showResults(currentResultQuestion + 1); } } catch (e) { console.error("Error navigating to next result:", e); debugLog("Failed to navigate to next result: " + e.message); } } // Lazy-load video function loadVideo(button, videoUrl, containerId) { try { debugLog(`Loading video for ${containerId}: ${videoUrl}`); if (!videoUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No video available</p>`; button.remove(); debugLog("No video URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <div class="video-loading"></div> <video controls class="w-full max-w-[600px] rounded-lg" preload="metadata" aria-label="Video explanation"> <source src="${videoUrl}" type="${videoUrl.endsWith('.m3u8') ? 'application/x-mpegURL' : 'video/mp4'}"> Your browser does not support the video tag. </video> `; container.classList.add('active'); button.remove(); // Initialize HLS.js for .m3u8 videos const video = container.querySelector('video'); if (videoUrl.endsWith('.m3u8') && Hls.isSupported()) { const hls = new Hls(); hls.loadSource(videoUrl); hls.attachMedia(video); hls.on(Hls.Events.ERROR, (event, data) => { console.error("HLS.js error:", data); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("HLS.js error: " + JSON.stringify(data)); }); } else if (videoUrl.endsWith('.m3u8') && video.canPlayType('application/vnd.apple.mpegurl')) { video.src = videoUrl; } // Handle video load errors video.onerror = () => { console.error("Video load error for URL:", videoUrl); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; debugLog("Video load error for URL: " + videoUrl); }; // Remove loading spinner when video is ready video.onloadedmetadata = () => { container.querySelector('.video-loading').remove(); debugLog("Video loaded successfully"); }; } catch (e) { console.error("Error loading video:", e); debugLog("Failed to load video: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading video. <a href="${videoUrl}" target="_blank" aria-label="Open video in new tab">Open video</a></p>`; } } // Lazy-load audio function loadAudio(button, audioUrl, containerId) { try { debugLog(`Loading audio for ${containerId}: ${audioUrl}`); if (!audioUrl) { const container = document.getElementById(containerId); container.innerHTML = `<p class="text-gray-500">No audio available</p>`; button.remove(); debugLog("No audio URL provided"); return; } const container = document.getElementById(containerId); container.innerHTML = ` <audio controls class="w-full max-w-[600px]" preload="metadata" aria-label="Audio explanation"> <source src="${audioUrl}" type="audio/mpeg"> Your browser does not support the audio tag. </audio> `; container.classList.add('active'); button.remove(); // Handle audio load errors const audio = container.querySelector('audio'); audio.onerror = () => { console.error("Audio load error for URL:", audioUrl); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; debugLog("Audio load error for URL: " + audioUrl); }; debugLog("Audio loaded successfully"); } catch (e) { console.error("Error loading audio:", e); debugLog("Failed to load audio: " + e.message); const container = document.getElementById(containerId); container.innerHTML = `<p class="text-red-500">Error loading audio. <a href="${audioUrl}" target="_blank" aria-label="Open audio in new tab">Open audio</a></p>`; } } // Toggle dark mode function toggleTheme() { try { debugLog("Toggling theme"); document.documentElement.classList.toggle('dark'); localStorage.setItem('theme', document.documentElement.classList.contains('dark') ? 'dark' : 'light'); debugLog("Theme toggled successfully"); } catch (e) { console.error("Error toggling theme:", e); debugLog("Failed to toggle theme: " + e.message); } } // Load theme preference function loadTheme() { try { debugLog("Loading theme preference"); const theme = localStorage.getItem('theme'); if (theme === 'dark') { document.documentElement.classList.add('dark'); } debugLog("Theme loaded successfully"); } catch (e) { console.error("Error loading theme:", e); debugLog("Failed to load theme: " + e.message); } } // Initialize on DOM content loaded window.addEventListener('DOMContentLoaded', () => { try { debugLog("DOM content loaded, initializing quiz"); loadTheme(); initQuiz(); } catch (e) { console.error("Error during DOMContentLoaded:", e); debugLog("Failed to initialize on DOMContentLoaded: " + e.message); document.getElementById('error-message').innerHTML = "Error initializing quiz. Please check the console for details or contact support."; document.getElementById('error-message').classList.remove('hidden'); } }); </script> </body> </html>" frameborder="0" width="100%" height="2000px">